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Review
. 2017 Mar;96(13):e6394.
doi: 10.1097/MD.0000000000006394.

Do renin-angiotensin system inhibitors influence the recurrence, metastasis, and survival in cancer patients?: Evidence from a meta-analysis including 55 studies

Hong Sun  1 , Tao Li, Rongyuan Zhuang, Weimin Cai, Yuanting Zheng
Affiliations
Review

Do renin-angiotensin system inhibitors influence the recurrence, metastasis, and survival in cancer patients?: Evidence from a meta-analysis including 55 studies

Hong Sun et al. Medicine (Baltimore). 2017 Mar.

Abstract

Background: Renin-angiotensin system inhibitors (RAS inhibitors) are antihypertensive agents with potential antitumor effects. However, various studies have yielded conflicting results on the influence of RAS inhibitors on survival of cancer patients. The aim of this study was to evaluate the effect of RAS inhibitors on recurrence, metastasis, and survival in cancer patients through a meta-analysis.

Methods: PubMed, Web of Science, EMBASE, and Cochrane Library were systematically searched from inception to December 2016. The pooled hazard ratio (HR) with its 95% confidence interval (95% CI) was calculated to evaluate the association between RAS inhibitors and recurrence, metastasis, and survival in cancer patients.

Results: Fifty-five eligible studies were included in the present meta-analysis. Results showed that there were significant improvements in overall survival (OS) (HR = 0.82; 95% CI: 0.77-0.88; P < 0.001), progression-free survival (HR = 0.74; 95% CI: 0.66-0.84; P < 0.001), and disease-free survival (HR = 0.80; 95% CI: 0.67-0.95; P = 0.01) in RAS inhibitor users compared with nonusers. Subgroup analyses revealed that the effect of RAS inhibitors on OS depended on the cancer type or different RAS inhibitors.

Conclusion: This meta-analysis suggests that RAS inhibitors could improve the survival of cancer patients and depend on cancer type and types of RAS inhibitors.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of study searching and selection.
Figure 2
Figure 2
Forest plot for the association between renin–angiotensin system inhibitors and overall survival of cancer patients.
Figure 3
Figure 3
Funnel plot of the association between renin–angiotensin system inhibitors and progression-free survival of cancer patients.
Figure 4
Figure 4
Funnel plot of the association between renin–angiotensin system inhibitors and disease-free survival of cancer patients.
Figure 5
Figure 5
Funnel plot of the association between renin–angiotensin system inhibitors and disease-specific survival of cancer patients.
Figure 6
Figure 6
Funnel plot of the association between renin–angiotensin system inhibitors and metastasis-free survival of cancer patients.
Figure 7
Figure 7
Forest plot for the subgroup analysis of cancer types.
Figure 8
Figure 8
Forest plot for the subgroup analysis of ethnicity.
Figure 9
Figure 9
Forest plot for the subgroup analysis of drug types of renin–angiotensin system inhibitors.
Figure 10
Figure 10
Funnel plot for publication bias test.
See this image and copyright information in PMC

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