Effect of Angiotensin System Inhibitors on Survival in Patients Receiving Chemotherapy for Advanced Non-Small-Cell Lung Cancer.
Effect of Angiotensin System Inhibitors on Survival in Patients Receiving Chemotherapy for Advanced Non-Small-Cell Lung Cancer.
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DOI：
10.1016/j.cllc.2016.07.008
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发表时间：
2017-03
影响因子：
3.6
通讯作者：
Ritzwoller DP
中科院分区：
文献类型：
--
作者：
Menter AR;Carroll NM;Sakoda LC;Delate T;Hornbrook MC;Jain RK;Kushi LH;Quinn VP;Ritzwoller DP
临床前研究表明，血管紧张素系统抑制剂（ASI）和贝伐单抗可改善肿瘤灌注和化疗疗效。我们进行了一项回顾性研究，以检查在卡铂和紫杉醇（CP）治疗期间，不使用贝伐单抗（CPB）或联合使用ASI是否与晚期非鳞状非小细胞肺癌（NS-NSCLC）患者的总生存率提高有关。在一项回顾性队列研究中，2005年至2011年间诊断为iii期ib或IV期NS-NSCLC的成年患者从Kaiser Permanente四个地区之一的肿瘤登记中被确定。使用倾向评分匹配的比例风险模型评估接受和未接受ASIs合并化疗（CP或CPB）的患者之间的生存差异。总生存期（OS）从化疗开始至死亡、退组或2012年12月31日测量。在纳入的1465例CP和348例CPB患者中，分别有273例（19%）和78例（22%）患者接受了合并ASI。对于伴有和未伴有ASI暴露的CP患者，中位总生存期（OS）分别为12.0和8.4个月（粗风险比（HR） 0.72, 95%可信区间（CI） 0.63-0.84）。CPB患者的中位OS分别为14.9个月和11.9个月（粗HR 0.77, 95% CI 0.57-1.02）。使用倾向评分匹配的队列，CP患者同时使用ASI的HR为0.73(95%可信区间（CI）， 0.61-0.88)， CPB患者的HR为0.79 （95% CI, 0.51-1.21）。NS-NSCLC在CP或CPB治疗期间同时接受ASI与生存率的提高相关，尽管这种关联仅在CP组具有统计学意义。
Pre-clinical studies suggest that angiotensin system inhibitors (ASI) and bevacizumab improve tumor perfusion and chemotherapy efficacy. We performed a retrospective study to examine whether concomitant ASI use during carboplatin and paclitaxel (CP) without or with bevacizumab (CPB) is associated with improved overall survival in patients with advanced non-squamous non-small cell lung cancer (NS-NSCLC). In a retrospective cohort study, adult patients diagnosed with stage IIIB or IV NS-NSCLC between 2005 and 2011 were identified from tumor registries at one of four Kaiser Permanente regions. Survival differences between those who did and did not receive ASIs concomitant with chemotherapy (CP or CPB) were assessed using propensity score matched proportional hazard models. Overall survival (OS) was measured from the initiation of chemotherapy until death, disenrollment, or December 31, 2012. Of the 1,465 CP and 348 CPB patients included, 273 (19%) and 78 (22%), respectively, received concomitant ASI. For CP patients with and without concomitant ASI exposure, median overall survival (OS) was 12.0 and 8.4 months, respectively (crude hazard ratio (HR) 0.72, 95% confidence interval (CI) 0.63–0.84). For CPB patients comparable median OS was 14.9 and 11.9 months, respectively (crude HR 0.77, 95% CI 0.57–1.02). Using propensity score matched cohorts, the HR for concomitant ASI use was 0.73 (95% confidence interval (CI), 0.61–0.88), for CP patients and 0.79 (95% CI, 0.51–1.21) for CPB patients. Concomitant ASI receipt during CP or CPB therapy for NS-NSCLC was associated with improved survival, though the association was only statistically significant in the CP group.