Exposure to ACEI/ARB and β-Blockers Is Associated with Improved Survival and Decreased Tumor Progression and Hospitalizations in Patients with Advanced Colon Cancer
Exposure to ACEI/ARB and β-Blockers Is Associated with Improved Survival and Decreased Tumor Progression and Hospitalizations in Patients with Advanced Colon Cancer
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DOI：
10.1593/tlo.13346
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发表时间：
2013-10-01
影响因子：
5
通讯作者：
Garcia, Jose M.
中科院分区：
文献类型：
--
作者：
Engineer, Diana R.;Burney, Basil O.;Garcia, Jose M.
背景：晚期结肠癌与体重减轻和生存率下降有关。研究表明，血管紧张素和β-肾上腺素能阻滞剂可减缓结肠癌进展并改善体重减轻。本研究旨在确定暴露于β-肾上腺素受体阻滞剂（BB）、血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）是否与结直肠癌死亡率降低、肿瘤进展、住院次数或体重减轻相关。方法：回顾性病历审查包括晚期结直肠癌患者。收集生存、分期、住院、癌症进展、癌症治疗和体重史。结果：425例新的III至IV期结直肠癌病例中有262例符合研究标准。那些接触ACEI/ARB、BB或两者都接触的人更容易患糖尿病、高血压和III期结直肠癌。调整年龄、高血压和糖尿病的存在和分期，与未暴露个体相比，ACEI/ARB + BB暴露与死亡率降低相关[风险比（HR）= 0.5，置信区间（CI）= 0.29-0.85;考克斯回归，P = 0.01]。与未暴露组相比，ACEI/ARB + BB组的总住院率和癌症相关住院率更低，癌症进展也更慢（HR = 0.59，CI = 0.36-0.99，P = 0.047）。暴露不影响体重变化;此外，从诊断前和诊断时到诊断后6、12、18和24个月的体重变化可预测生存率。结论：我们观察到ACEI/ ARB + BB联合用药与晚期结直肠癌生存率增加、住院率降低和肿瘤进展降低之间存在相关性。未来的研究将需要复制这些结果，并将其推广到更广泛的人群。因果关系的确定需要随机对照试验。
BACKGROUND: Advanced colon cancer is associated with weight loss and decreased survival. Studies suggest that angiotensin and beta-adrenergic blockade decrease colon cancer progression and ameliorate weight loss. This study aims to determine whether exposure to beta-adrenoceptor blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs) is associated with decreased mortality, tumor progression, number of hospitalizations, or weight loss in colorectal cancer. METHODS: Retrospective chart review included patients with advanced colorectal cancer. Survival, stage, hospitalization, cancer progression, cancer treatment, and body weight history were collected. RESULTS: Two hundred sixty-two of 425 new stage III to IV colorectal cancer cases reviewed met the study criteria. Those exposed to ACEI/ARB, BB, or both were more likely to have diabetes, hypertension, and stage III colorectal cancer. Adjusting for age, presence of hypertension and diabetes, and stage, ACEI/ARB + BB exposure was associated with decreased mortality compared to unexposed individuals [hazard ratio (HR) = 0.5, confidence interval (CI) = 0.29-0.85; Cox regression, P =.01]. Fewer total and cancer-related hospitalizations and decreased cancer progression in the ACEI/ARB + BB group versus the unexposed group (HR = 0.59, CI = 0.36-0.99, P =.047) were seen. Exposure did not affect weight changes; furthermore, body weight changes from both prediagnosis and at diagnosis to 6, 12, 18, and 24 months postdiagnosis predicted survival. CONCLUSIONS: We have observed an association between exposure to a combination of ACEI/ ARB + BB and increased survival, decreased hospitalizations, and decreased tumor progression in advanced colorectal cancer. Future studies will be needed to replicate these results and generalize them to broader populations. Determination of causality will require a randomized controlled trial.