Renin-Angiotensin system blockers may prolong survival of metastatic non-small cell lung cancer patients receiving erlotinib.
Renin-Angiotensin system blockers may prolong survival of metastatic non-small cell lung cancer patients receiving erlotinib.
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DOI：
10.1097/md.0000000000000887
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发表时间：
2015-06
期刊：
影响因子：
1.6
通讯作者：
Sen F
中科院分区：
文献类型：
--
作者：
Aydiner A;Ciftci R;Sen F
本研究的目的是确定肾素-血管紧张素系统阻滞剂(RASB)，包括血管紧张素转换酶抑制剂(ACEI)和血管紧张素-2受体1阻滞剂(ARB)是否能提高转移性非小细胞肺癌(NSCLC)患者的总体生存率。对117例转移性非小细胞肺癌患者的病历资料进行了回顾分析。37名患者(RASB组)在系统治疗期间使用RASBS，并与80名在诊断为NSCLC后未使用RASBS的对照组(对照组)进行比较。记录组织学肿瘤亚型、表现状态、年龄、性别、吸烟情况、合并症、其他药物、化疗药物(CT)和厄洛替尼。我们比较了RASB组和对照组患者的OS。患者的中位年龄(±SD)为61(±1)岁，所有患者均接受全身治疗(CT或厄洛替尼)。与对照组相比，RASB组患者更有可能是吸烟者、高血压和缺血性心脏病，并使用厄洛替尼、噻嗪类、β-受体阻滞剂和钙通道阻滞剂(均为P <； 0.05)。整个组的中位随访时间为18.9个月(范围为1-102个月)。RASB组中位随访期长于对照组(17个月比11个月，P = 0.033)。最常用的rasb药物是valsartan(n = 12/37)。在分析时，所有患者中有98人(83.7%)已经死亡。单因素分析显示，RASB组的中位OS长于对照组(17±4.1比12[±1.4]个月，P = 0.016)。有趣的是，进一步的分析显示，只有在与厄洛替尼同时使用时，RASB才能显著改善OS(34[±13.8]个月比25[±5]个月，P = 0.002)，而且OS的好处更多地归因于ARB，因为只有4名患者同时接受ACEI和厄洛替尼治疗。然而，在多因素分析中，ARB对OS的益处消失了。在厄洛替尼治疗期间使用ARB可能延长转移性非小细胞肺癌患者的OS。
The aim of this study is to determine whether renin-angiotensin system blockers (RASBs), which include angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-2 receptor 1 blockers (ARBs), improve the overall survival (OS) of patients with metastatic non-small cell lung cancer (NSCLC). The medical charts of 117 patients with metastatic NSCLC were retrospectively assessed. Thirty-seven patients (RASB group) using RASBs during systemic treatment were compared with 80 controls (control group) who did not use RASBs following the diagnosis of NSCLC. The histological tumor subtype, performance status, age, sex, smoking status, comorbidities, other medications, chemotherapeutics (CT), and erlotinib that were received in any line of treatment were recorded. We compared the OS of the patients in the RASB and control groups. The median (±SD) age of the patients was 61 (±1) years and all patients were administered systemic treatment (CT or erlotinib). The patients in RASB group were more likely to be smokers, have hypertension and ischemic heart disease, and use erlotinib, thiazides, beta-blockers, and calcium-channel blockers (P < 0.05 for all) compared with the control group. The median follow-up time was 18.9 months (range 1–102 months) for the entire group. The median follow-up period was longer for RASB group than control group (17 vs 11 months, P = 0.033). The most commonly prescribed RASB agent was valsartan (n = 12/37). At the time of the analysis, 98 (83.7%) of all patients had died. In the univariate analysis, the median OS was longer in the RASB group compared with the control group (17 [±4.1] vs 12 [±1.4] months, P = 0.016). Interestingly, further analyses revealed that RASBs significantly improved OS only if used with erlotinib concurrently (34 [±13.8] vs 25 [±5] months, P = 0.002) and the OS benefit was more attributable to ARBs because only 4 patients received ACEI and erlotinib concurrently. However, the benefit of ARBs on OS disappeared in the multivariate analysis. The use of ARBs during erlotinib treatment may prolong OS of patients with metastatic NSCLC.