Abstract
Background
Renin-angiotensin system (RAS) inhibitors are effective for treating patients with
cancer. The present study evaluated the impact of RAS inhibitors, including angiotensin-2
converting enzyme inhibitors and angiotensin 2 receptor blockers, after patients underwent
radical surgery for upper urinary tract urothelial carcinoma (UTUC).
Methods
This retrospective study included 312 patients with nonmetastatic UTUC who underwent
radical surgery. The oncological outcomes of patients treated or not treated with
RAS inhibitors following surgery were evaluated. Recurrence-free survival (RFS), cancer-specific
survival (CSS), and overall survival (OS) were assessed using the Kaplan-Meier method
and Cox regression analysis.
Results
The median follow-up duration after radical surgery was 44.7 months. The 5-year RFS,
CSS, and OS rates of patients who did or did not receive RAS inhibitors were 82.3%
versus 68.9% (P = .018), 88.9% versus 71.8% (P = .0044), and 68.7% versus 61.8% (P = .047), respectively. Multivariable analyses revealed that the use of RAS inhibitors
was an independent prognostic factor for RFS, CSS, and OS (hazard ratio [HR] 0.48,
P = .013; HR 0.31, P = .002; and HR 0.52, P = .01, respectively). Moreover, patients treated with RAS inhibitors versus untreated
patients had better 5-year RFS compared with those in the pT2 and < pN1 subgroups
(pT2: 100.0% vs. 62.2%, P = .014 and < pN1: 87.2% vs. 74.7%, P = .034).
Conclusions
RAS inhibitors significantly improved RFS, CSS, and OS of patients with UTUC who underwent
radical surgery. These agents may be particularly beneficial for patients with stage
pT2 or < pN1 disease.
Keywords
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Article info
Publication history
Published online: May 10, 2017
Accepted:
May 1,
2017
Received in revised form:
April 25,
2017
Received:
February 23,
2017
Footnotes
T.Y. and T.M. contributed equally to the work and should be regarded as first authors.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
