肾素-血管紧张素系统抑制剂可改善胆管癌患者的生存率：一项倾向评分匹配队列研究。

Renin-angiotensin system inhibitors improve the survival of cholangiocarcinoma: a propensity score-matched cohort study.

机构信息

Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, China.

出版信息

BMC Cancer. 2023 Sep 5;23(1):826. doi: 10.1186/s12885-023-11152-2.

DOI:10.1186/s12885-023-11152-2

PMID:37670280

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10478452/

Abstract

BACKGROUND

Hypertension is a risk factor for cholangiocarcinoma (CCA). The effect of anti-hypertensive drugs on the prognosis of CCA is not clear.

METHODS

This is a retrospective study of 102 patients (56.9% males, median age 66 years) diagnosed with CCA and hypertension concurrently and received radical surgery (R0), with a median follow-up of 36.7 months. Kaplan-Meier analysis, Cox regressions, and propensity score (PS) matching were applied for statistical analysis.

RESULTS

Results of multivariable cox analysis showed that renin-angiotensin system inhibitors (RASis) usage was a protective factor for progression-free survival (PFS) (hazard ratio [HR] = 0.55, 95% confidence interval [95% CI]: 0.32-0.96) and overall survival (OS) (HR = 0.40, 95% CI: 0.20-0.79), respectively. Calcium channel blockers, diuretics, and β-blockers didn't show significant associations. The association of RASis usage and PFS and OS was derived by PS matching, with a cohort of 28 RASis users and 56 RASis non-users. The median PFS and OS of RASis users (PFS, 17.6 months (9.2-34.4); OS, 24.8 months (16.5-42.3)) were longer than RASis non-users (PFS, 10.5 months (4.1-24.1); OS, 14.6 months (10.6-28.4)). The 1 year, 2 years, and 3 years' survival rates of RASis users (89.1%, 77.0%, and 65.5%) were higher than RASis non-users (70.9%, 54.0%, and 40.0%).

CONCLUSIONS

RASis usage improves the survival of patients with CCA and hypertension concurrently.

摘要

背景

高血压是胆管癌（CCA）的一个危险因素。降压药物对 CCA 预后的影响尚不清楚。

方法

这是一项回顾性研究，纳入了 102 例（男性占 56.9%，中位年龄 66 岁）同时诊断为 CCA 和高血压并行根治性手术（R0）的患者，中位随访时间为 36.7 个月。采用 Kaplan-Meier 分析、Cox 回归和倾向评分（PS）匹配进行统计学分析。

结果

多变量 Cox 分析结果显示，血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）的使用是无进展生存期（PFS）（风险比 [HR] = 0.55，95%置信区间 [95%CI]：0.32-0.96）和总生存期（OS）（HR = 0.40，95%CI：0.20-0.79）的保护因素。钙通道阻滞剂、利尿剂和β受体阻滞剂与 PFS 和 OS 无显著相关性。PS 匹配后得出 ACEI/ARB 使用与 PFS 和 OS 的相关性，有 28 名 ACEI/ARB 使用者和 56 名 ACEI/ARB 非使用者。ACEI/ARB 使用者的中位 PFS 和 OS 更长（PFS，17.6 个月（9.2-34.4）；OS，24.8 个月（16.5-42.3）），而非 ACEI/ARB 使用者的中位 PFS 和 OS 更短（PFS，10.5 个月（4.1-24.1）；OS，14.6 个月（10.6-28.4））。ACEI/ARB 使用者的 1 年、2 年和 3 年生存率（89.1%、77.0%和 65.5%）高于 ACEI/ARB 非使用者（70.9%、54.0%和 40.0%）。