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. 2017 Nov;5(7):987-996.
doi: 10.1177/2050640617695698. Epub 2017 Feb 26.

Use of inhibitors of the renin-angiotensin system is associated with longer survival in patients with hepatocellular carcinoma

Matthias Pinter  1   2 , Arndt Weinmann  3   4   5 , Marcus-Alexander Wörns  3   4 , Florian Hucke  1   6 , Simona Bota  1   6 , Jens U Marquardt  3   4 , Dan G Duda  2 , Rakesh K Jain  2 , Peter R Galle  3   4 , Michael Trauner  1 , Markus Peck-Radosavljevic  1   6 , Wolfgang Sieghart  1
Affiliations

Use of inhibitors of the renin-angiotensin system is associated with longer survival in patients with hepatocellular carcinoma

Matthias Pinter et al. United European Gastroenterol J. 2017 Nov.

Abstract

Background: Inhibition of the renin-angiotensin system (RAS) was associated with longer survival in patients with different solid malignancies.

Objective: The objective of this study was to investigate the effect of RAS inhibitor (RASi) treatment (angiotensin-converting enzyme inhibitors or angiotensin-II-receptor blockers) on survival of patients with hepatocellular carcinoma (HCC).

Methods: Patients diagnosed with HCC and Child-Pugh A between 1992 and 2013 who received sorafenib, experimental therapy, or best supportive care were eligible for the Vienna cohort. The Mainz cohort included patients with HCC and Child-Pugh A who received sorafenib treatment between 2007 and 2016. The association between RASi and overall survival (OS) was evaluated in univariate and multivariate analyses.

Results: In the Vienna cohort, 43 of 156 patients received RASi for hypertension. RASi treatment was associated with longer OS (11.9 vs. 6.8 months (mo); p = 0.014) and remained a significant prognostic factor upon multivariate analysis (HR = 0.6; 95% CI 0.4-0.9; p = 0.011). In subgroup analysis, patients treated with sorafenib plus RASi had better median OS (19.5 mo) compared to those treated with either sorafenib (10.9 mo) or RASi (9.7 mo) alone (p = 0.043). The beneficial effect of RASi on survival was confirmed in the Mainz cohort (n = 76).

Conclusion: RAS inhibition is associated with longer survival in HCC patients with Child-Pugh class A.

Keywords: Hepatocellular carcinoma; angiotensin II receptor blocker; angiotensin-converting enzyme inhibitor; renin–angiotensin system; sorafenib.

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Figures

Figure 1.
Figure 1.
Flow chart of patient selection. HCC, hepatocellular carcinoma.
Figure 2.
Figure 2.
Kaplan–Meier survival curves. Survival according to renin–angiotensin system inhibitor (RASi) treatment in the Vienna (a) and Mainz cohort (b) and according to treatment with sorafenib (SOR) alone, neither SOR nor RASi, SOR+RASi, and RASi alone in the Vienna cohort (c).
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