Efficacy of Renin-Angiotensin System Inhibitors in Long-Term Oncologic Outcomes of Patients With Stage II/III Colon Cancer and Hypertension: A Target Trial Emulation.

Abstract

Renin-angiotensin system inhibitors (RASIs) have been reported to exert anticancer effects. However, there is still a lack of persuasive evidence for their role in improving postoperative long-term oncologic outcomes of colorectal cancer. This retrospective cohort study emulated a hypothetical randomized controlled trial to evaluate the efficacy of RASIs in improving postoperative long-term oncologic outcomes of patients with stage II/III colon cancer and hypertension. Patients were consecutively enrolled from multicenter databases, which contained data from medical centers in Shanghai, China. Eligible criteria were adults with radical resected stage II or III colon adenocarcinoma and hypertension. Eligible patients were classified into the RASI group or the no-RASI group, and propensity score was matched at a 1:1 ratio. The primary outcome was the 3-year disease-free survival (DFS) rate. From 2,640 eligible patients, 2,292 were included in the primary analysis after matching: 1,146 in the RASI group and 1,146 in the no-RASI group. The median follow-up time was 46.3 months. The RASI group had a higher 3-year DFS rate (83.4% <i>v</i> 78.3%; <i>P</i> = .001; hazard ratio [HR], 0.736 [95% CI, 0.617 to 0.878]). The RASI group also had a lower 3-year distant metastasis rate (15.6% <i>v</i> 20.5%; <i>P</i> < .001; HR, 0.717 [95% CI, 0.596 to 0.863]) and a higher 3-year overall survival rate (92.4% <i>v</i> 89.6%; <i>P</i> = .001; HR, 0.682 [95% CI, 0.539 to 0.864]). RASIs may improve the postoperative long-term oncologic outcomes for patients with stage II/III colon cancer and hypertension.