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Meta-Analysis
. 2019 Jun 7;19(1):49.
doi: 10.1186/s12894-019-0481-5.

Hypertension as a prognostic factor in metastatic renal cell carcinoma treated with tyrosine kinase inhibitors: a systematic review and meta-analysis

Yu Liu  1 , Liang Zhou  1 , Yuntian Chen  1 , Banghua Liao  1 , Donghui Ye  1 , Kunjie Wang  2 , Hong Li  1
Affiliations
Meta-Analysis

Hypertension as a prognostic factor in metastatic renal cell carcinoma treated with tyrosine kinase inhibitors: a systematic review and meta-analysis

Yu Liu et al. BMC Urol. .

Abstract

Background: Conflicting evidence exists regarding the effect of hypertension on the prognosis of metastatic renal cell carcinoma (mRCC) patients treated with tyrosine kinase inhibitors (TKIs). This study aimed to assess the predictive value of TKIs-induced hypertension in patients with mRCC.

Methods: This study was registered in PROSPERO (CRD42019129593). PubMed, Embase, Web of Science and the Cochrane Library database were searched with terms: "renal cell carcinoma", "hypertension", "blood pressure", "tyrosine kinase inhibitor", "sunitinib", "axitinib", "sorafenib" and "pazopanib" until March 21, 2019. Hazard Ratios (HR) and 95% confidence intervals (CI) for progression-free survival (PFS) or overall survival (OS) were extracted and analyzed with Stata 15.0 software. Heterogeneity was assessed using the I2 value. Meta-regression, subgroup analysis and sensitivity analysis were also performed to explore heterogeneity. Publication bias was assessed with funnel plots and precisely assessed by Egger's and Begg's tests. The quality of evidence of outcomes was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Results: A total of 4661 patients from 22 studies were included in the study. The results showed that the increase of blood pressure was an effective predictor for longer PFS (HR = 0.59, 95% CI: 0.48-0.71, p < 0.001; I2 = 77.3%) and OS (HR = 0.57, 95% CI: 0.45-0.70, p < 0.001; I2 = 77.4%) of patients with mRCC. Subgroup analysis revealed that patients receiving sunitinib and pazopanib could have longer PFS and OS.

Conclusions: This study indicated that TKIs-induced hypertension may be a good predictor for better prognosis of patients with mRCC receiving TKIs treatment, especially using sunitinib or pazopanib.

Keywords: Hypertension; Meta-analysis; Metastatic renal cell carcinoma; Prognosis; Tyrosine kinase inhibitors.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Forest plot reflects the association between TKIs -induced hypertension and oncologic outcomes (progression free survival) in different TKIs subgroups (1: axitinib; 2: sorafenib; 3: sunitinib; 4: pazopanib)
Fig. 2
Fig. 2
Forest plot reflects the association between TKIs-induced hypertension and oncologic outcomes (overall survival) in different TKIs subgroups (1: axitinib; 2: sorafenib; 3: sunitinib; 4: pazopanib)
Fig. 3
Fig. 3
Sensitivity analysis of progression free survival for the evaluation of potential heterogeneity
Fig. 4
Fig. 4
Funnel plot for publication bias. a progression free survival, b overall survival
See this image and copyright information in PMC

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