肾素-血管紧张素系统抑制剂对直肠癌患者生存的影响。

Impact of renin-angiotensin system inhibitors on the survival of patients with rectal cancer.

机构信息

Gliwice Branch, The Oncologic and Reconstructive Surgery Clinic, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102, Gliwice, Poland.

Department of Biostatistics and Bioinformatics, Gliwice Branch, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102, Gliwice, Poland.

出版信息

BMC Cancer. 2022 Jul 25;22(1):815. doi: 10.1186/s12885-022-09919-0.

DOI:10.1186/s12885-022-09919-0

PMID:35879682

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9316329/

Abstract

BACKGROUND

Renin-angiotensin system inhibitors (RASIs) are widely used in the treatment of hypertension. However, their impact on the outcome of the combined treatment of rectal cancer is poorly understood. The aim of this study was to assess the effect of RASIs on the survival of rectal cancer patients with associated hypertension after neoadjuvant treatment and radical resection.

METHODS

Between 2008 and 2016, 242 radical (R0) rectal resections for cancer were performed after neoadjuvant treatment in patients with associated hypertension. At the time of treatment, 158 patients were on RASIs, including 35 angiotensin-receptor antagonists (ARB) users and 123 angiotensin-converting enzyme inhibitors (ACEI) users. Eighty-four patients were on drugs other than RASIs (non-RASI users). The survival analysis was performed using the Kaplan-Meier estimator with the log-rank test and the Cox proportional hazards model.

RESULTS

The log-rank test showed a significantly worse overall survival (OS) in the group of ACEI users compared to ARB users (p = 0.009) and non-RASI users (p = 0.013). Disease-free survival (DFS) was better in the group of ARB users compared to ACEI users. However, the difference was not statistically significant (p = 0.064). The Multivariate Cox analysis showed a significant beneficial effect of ARBs on OS (HR: 0.326, 95% CI: 0.147-0.724, p = 0.006) and ARBs on DFS (HR: 0.339, 95% CI: 0.135-0.850, p = 0.021) compared to ACEIs. Other factors affecting OS included age (HR: 1.044, 95% CI: 1.016-1.073, p = 0.002), regional lymph node metastasis (ypN +) (HR: 2.157, 95% CI: 1.395-3.334, p = 0.001) and perineural invasion (PNI) (HR: 3.864, 95% CI: 1.799-8.301, p = 0.001). Additional factors affecting DFS included ypN + (HR: 2.310, 95% CI: 1.374-3.883, p = 0.002) and PNI (HR: 4.351, 95% CI: 1.584-11.954, p = 0.004).

CONCLUSIONS

The use of ARBs instead of ACEIs may improve the outcome of the combined therapy for rectal cancer patients with associated hypertension.

摘要

背景

肾素-血管紧张素系统抑制剂（RASIs）广泛用于治疗高血压。然而，它们对新辅助治疗和根治性切除术联合治疗直肠癌的结果的影响知之甚少。本研究旨在评估 RASI 对合并高血压的直肠癌患者新辅助治疗和根治性切除术后生存的影响。

方法

2008 年至 2016 年间，242 例伴有高血压的直肠癌患者在新辅助治疗后接受了根治性（R0）直肠切除术。在治疗时，158 例患者正在服用 RASI，包括 35 例血管紧张素受体拮抗剂（ARB）使用者和 123 例血管紧张素转换酶抑制剂（ACEI）使用者。84 例患者服用非 RASI 药物（非 RASI 使用者）。使用 Kaplan-Meier 估计器和对数秩检验以及 Cox 比例风险模型进行生存分析。

结果

对数秩检验显示 ACEI 使用者的总体生存（OS）明显差于 ARB 使用者（p=0.009）和非 RASI 使用者（p=0.013）。ARB 使用者的无病生存（DFS）优于 ACEI 使用者。然而，差异无统计学意义（p=0.064）。多变量 Cox 分析显示 ARB 对 OS（HR：0.326，95%CI：0.147-0.724，p=0.006）和 ARB 对 DFS（HR：0.339，95%CI：0.135-0.850，p=0.021）的有益作用明显优于 ACEI。影响 OS 的其他因素包括年龄（HR：1.044，95%CI：1.016-1.073，p=0.002）、区域淋巴结转移（ypN+）（HR：2.157，95%CI：1.395-3.334，p=0.001）和神经周围侵犯（PNI）（HR：3.864，95%CI：1.799-8.301，p=0.001）。影响 DFS 的其他因素包括 ypN+（HR：2.310，95%CI：1.374-3.883，p=0.002）和 PNI（HR：4.351，95%CI：1.584-11.954，p=0.004）。