Abstract
Background: Inhibition of the renin–angiotensin system (RAS) was associated with longer survival in patients with different solid malignancies. Objective: The objective of this study was to investigate the effect of RAS inhibitor (RASi) treatment (angiotensin-converting enzyme inhibitors or angiotensin-II-receptor blockers) on survival of patients with hepatocellular carcinoma (HCC). Methods: Patients diagnosed with HCC and Child-Pugh A between 1992 and 2013 who received sorafenib, experimental therapy, or best supportive care were eligible for the Vienna cohort. The Mainz cohort included patients with HCC and Child-Pugh A who received sorafenib treatment between 2007 and 2016. The association between RASi and overall survival (OS) was evaluated in univariate and multivariate analyses. Results: In the Vienna cohort, 43 of 156 patients received RASi for hypertension. RASi treatment was associated with longer OS (11.9 vs. 6.8 months (mo); p = 0.014) and remained a significant prognostic factor upon multivariate analysis (HR = 0.6; 95% CI 0.4–0.9; p = 0.011). In subgroup analysis, patients treated with sorafenib plus RASi had better median OS (19.5 mo) compared to those treated with either sorafenib (10.9 mo) or RASi (9.7 mo) alone (p = 0.043). The beneficial effect of RASi on survival was confirmed in the Mainz cohort (n = 76). Conclusion: RAS inhibition is associated with longer survival in HCC patients with Child-Pugh class A.
| Original language | English |
|---|---|
| Journal | United European Gastroenterology Journal |
| Volume | 5 |
| Issue number | 7 |
| Pages (from-to) | 987-996 |
| Number of pages | 10 |
| ISSN | 2050-6406 |
| DOIs | |
| Publication status | Published - 01.11.2017 |
Funding
MP is supported by an Erwin-Schroedinger Fellowship by the Austrian Science Fund (FWF; project number J 3747-B28). JUM is supported by grants from the German Cancer Aid (DKH 110989) and the Volkswagen Foundation (Lichtenberg program). DGD and RKJ are supported by NIH grant P01-CA080124. M.P. received travel support and speaking fees from Bayer; A.W. received lecture and travel fees from Bayer Vital; M.A.W. received consulting and lecture fees from Bayer HealthCare; F.H. received travel support from Bayer; S.B. received travel support from Bayer; J.U.M. has no conflicts of interest; D.G.D. received research grants from Merrimack, Bayer and HealthCare Pharma; R.K.J. received consultant fees from Ophthotech, SPARC, SynDevRx, XTuit, owns equity in Enlight, Ophthotech, SynDevRx, XTuit, and serves on the Board of Directors of XTuit and the Boards of Trustees of Tekla Healthcare Investors, Tekla Life Sciences Investors, Tekla Healthcare Opportunities Fund, Tekla World Healthcare Fund; P.R.G. is consultant and speakers bureau member of Bayer Healthcare; P.R.G. received consulting and lecture fees from Bayer HealthCare, Lilly, BMS, MSD, Sillajen, Arqule, Sirtex, Blueprint; M.T. serves as a consultant for Albireo, Falk, Genfit, Gilead, Intercept, MSD, Novartis, Phenex and is a member of the speakers’ bureau of Falk, Gilead, MSD, Roche. He received travel grants from Falk, Roche, Gilead and unrestricted research grants from Albireo, Falk, Intercept, MSD. He is also coinventor of a patent on the medical use of norUDCA. M.P.R. is an investigator for AbbVie, Arqle-Daiichi, Bayer, BMS, Boehringer-Ingelheim, Imclone, Lilly, Novartis, Roche, a speaker and advisor for Abbott, Bayer, BMS, Boehringer-Ingelheim, Lilly, Novartis, Roche, and received grant support from AbbVie, Arqle-Daiichi, Bayer, Roche; W.S. received travel support and speaking fees from Bayer.
