School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, Taiwan.
Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
BMC Cancer. 2022 Apr 20;22(1):430. doi: 10.1186/s12885-022-09513-4.
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are used in treating cardiovascular diseases. Previous studies indicated that ACEIs/ARBs may benefit cancer patients by inhibiting tumor angiogenesis and proliferation. The effect of ACEIs/ARBs on cancer survival in esophageal and gastric cancer is still unclear. This study is to investigate the association between ACEIs/ARBs usage and esophageal and gastric cancer prognosis.
This retrospective cohort study identified esophageal and gastric cancer patients during 2008-2016 from the Taiwan Cancer Registry, and obtained medication usage and follow-up information from the National Health Insurance Research Database and Death Registry. Analysis groups were defined as ACEIs/ARBs user or non-user based on the usage of ACEIs/ARBs within the 6 months after cancer diagnosis. The stabilized inverse probability of treatment weighting using propensity scores was applied to balance covariates between study groups. We also used Kaplan-Meier estimates and Cox regression to compare survival outcome and estimate hazard ratios (HRs).
We identified 14,463 and 21,483 newly-diagnosed esophageal and gastric cancer patients during 2008-2016. ACEIs/ARBs users were associated with lower risk of cancer-specific mortality, although only significantly in gastric cancer (gastric: adjusted HR = 0.87, 95% CI = 0.78-0.97; esophageal: adjusted HR =0.88, 95% CI = 0.76-1.02). A better survival outcome was observed among patients who received higher cumulative defined daily dose of ACEIs/ARBs.
We found that using ACEIs/ARBs after cancer diagnosis were associated with lower risk of mortality. Our results add to the knowledge of the benefit of ACEIs/ARBs against mortality in individuals with esophageal/gastric cancer patients with hypertension.
血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）用于治疗心血管疾病。先前的研究表明，ACEI/ARB 通过抑制肿瘤血管生成和增殖可能使癌症患者受益。ACEI/ARB 对食管癌和胃癌患者的生存影响仍不清楚。本研究旨在探讨 ACEI/ARB 应用与食管癌和胃癌预后的关系。
本回顾性队列研究从台湾癌症登记处确定了 2008-2016 年期间的食管癌和胃癌患者，并从国民健康保险研究数据库和死亡登记处获得了药物使用和随访信息。分析组根据癌症诊断后 6 个月内 ACEI/ARB 的使用情况定义为 ACEI/ARB 使用者或非使用者。采用倾向评分稳定逆概率治疗加权法平衡研究组间的协变量。我们还使用 Kaplan-Meier 估计和 Cox 回归比较生存结果并估计风险比（HR）。
我们确定了 2008-2016 年间新诊断的 14463 例食管癌和 21483 例胃癌患者。ACEI/ARB 使用者的癌症特异性死亡率风险较低，尽管仅在胃癌中具有统计学意义（胃癌：调整后的 HR=0.87，95%CI=0.78-0.97；食管癌：调整后的 HR=0.88，95%CI=0.76-1.02）。接受更高累积 ACEI/ARB 定义日剂量的患者生存结果更好。
我们发现癌症诊断后使用 ACEI/ARB 与死亡率降低相关。我们的结果增加了 ACEI/ARB 对高血压合并食管癌/胃癌患者死亡率有益的知识。
