Retrospective clinical study of renin-angiotensin system blockers in lung cancer patients with hypertension

Jie Wei; Zhiyang Zhou; Zhijie Xu; Shuangshuang Zeng; Xi Chen; Xiang Wang; Wanli Liu; Min Liu; Zhicheng Gong; Yuanliang Yan

doi:10.7717/peerj.8188

Retrospective clinical study of renin-angiotensin system blockers in lung cancer patients with hypertension

PeerJ. 2019 Dec 10:7:e8188. doi: 10.7717/peerj.8188. eCollection 2019.

Authors

Jie Wei^#^{1

2}, Zhiyang Zhou^#³, Zhijie Xu⁴, Shuangshuang Zeng^{1

2}, Xi Chen^{1

2}, Xiang Wang^{1

2}, Wanli Liu^{1

2}, Min Liu^{1

2}, Zhicheng Gong^{1

2}, Yuanliang Yan^{1

2}

Affiliations

¹ Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, Hunan, China.
² Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
³ Department of Breast Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁴ Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, China.

^# Contributed equally.

Abstract

Purpose: Renin-angiotensin system blockers (RASBs), which include angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-2 receptor 1 blockers (ARBs), have been reported to be associated with lung cancer metastasis, radiotherapy and chemotherapy. Until now, very limited clinical data for RASBs' diagnostic and prognostic effects has existed for lung cancer chemotherapy in Chinese patients.

Methods: There were a total of 678 lung cancer patients with hypertension, of which 461 (68%) were in the non-RASBs group and 217 (32%) were in the RASBs group. Patients' gender, age, smoking status, histologic differentiation, tumor size, pathological grade, lymph node metastasis, pathological stage and progression-free survival (PFS) were retrospectively analyzed between these two groups. The clinical effects of ACEIs and ARBs in lung cancer patients were compared via t tests, and χ ² test, and potential prognostic factors for progression-free survival (PFS) were evaluated by Kaplan-Meier analysis.

Results: Significant differences were observed in lymph node metastasis between the RASBs and non-RASBs groups. The RASBs group (62.8% vs 71.7%, p = 0.037) and ARBs group (60.0% vs 71.7%, p = 0.030) had lower lymph node metastasis, and patients with RASBs had a lower pathological stage than those in non-RASBs groups (67.1% vs 77.4%, p = 0.044 ). The PFS of the RASBs (10.7 vs. 6.7 months, p = 0.040) and ACEIs (12.9 vs 6.7 months, p = 0.021) groups were longer than that of the non-RASBs group, while no statistical difference was shown between the ACEIs and ARBs groups. Moreover, the significant results of PFS were further confirmed in pathological stage III-IV patients. In the non-RASB group, 55% of patients took calcium channel blockers (CCBs), and the ACEIs group have a significantly longer PFS compared to the non-CCBs group (6.4 vs 12.9 months, p = 0.036).

Conclusion: In this study, we showed that the use of RASBs is a positive factor for pathological stage and prognosis of lung cancer patients. Therefore, it is necessary to actively evaluate medical history, especially the use of anti-hypertension medication, in patients with lung cancer and reflect medical history in the treatment and management plans of these patients.

Keywords: Clinical analysis; Hypertension; Lung cancer; Renin-angiotensin system blockers.

Grants and funding

This work is supported by the Natural Science Foundation of Hunan Province (2019JJ50932), National Natural Science Foundation of China (81803035, 81703036, 81572946), Hospital Management Research Foundation of Xiangya Hospital (No. 2016GL21), and Clinical Big Data System Construction Project of Central South University (No. 46). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.