Hypertension and angiotensin system inhibitors: impact on outcome in sunitinib-treated patients for metastatic renal cell carcinoma
Autor: | Hassane Izzedine, Bernard Escudier, Laurence Albiges, G. Le Teuff, Lisa Derosa |
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Rok vydání: | 2014 |
Předmět: |
Oncology
Adult Male medicine.medical_specialty Indoles Time Factors Angiogenesis Inhibitors Angiotensin-Converting Enzyme Inhibitors Blood Pressure Kaplan-Meier Estimate Gastroenterology Disease-Free Survival Renin-Angiotensin System Renal cell carcinoma Risk Factors Internal medicine Renin–angiotensin system medicine Sunitinib Humans In patient Pyrroles Carcinoma Renal Cell Aged Proportional Hazards Models Retrospective Studies Aged 80 and over Proportional hazards model business.industry Hazard ratio Hematology Middle Aged medicine.disease Confidence interval Kidney Neoplasms Treatment Outcome Concomitant Hypertension Multivariate Analysis Disease Progression Female France business Angiotensin II Type 1 Receptor Blockers medicine.drug |
Zdroj: | Annals of oncology : official journal of the European Society for Medical Oncology. 26(6) |
ISSN: | 1569-8041 |
Popis: | BACKGROUND To examine the association between hypertension (HTN), angiotensin system inhibitors (ASI) use and survival outcomes in patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib (SU). METHODS We retrospectively reviewed all patients with mRCC who received SU as first-line treatment in Gustave Roussy from April 2004 to November 2013. The HTN (either pre-existing or secondary to SU), use of ASI (either before or during SU) were analysed. Overall survival (OS) and progression-free survival (PFS) of different exposures were compared with log-rank test. The associations between exposures and survival outcomes were estimated with hazard ratios (HRs) and 95% confidence interval (CI) through a multivariable Cox model adjusted for age, gender, International mRCC Database Consortium risk group and histology. RESULTS Among 213 patients with a 3.6-year median follow-up, 134 were hypertensive and 105 were ASI users with a significant association between the two exposures (P < 0.0001). Hypertensive patients have longer OS (median: 41.6 versus 16.4 months, P < 0.0001) and longer PFS (median: 12.9 versus 5.6 months, P < 0.0001) than non-hypertensive patients (n = 79). ASI users (n = 105) had more HTN_PRE compared with those (n = 108) who did not (65% versus 19%, P < 0.001). Multivariable analysis showed that hypertensive patients were significantly associated with OS (P = 0.05) and marginally with PFS (P = 0.06) while ASI intake was significantly associated with better OS [HR = 0.40; 95% CI (0.24-0.66), P < 0.001] and PFS [HR = 0.55 (0.35-0.86), P = 0.009]. The latter remain statistically significantly associated after controlling for the number of metastases. There is no difference on outcome between patients who receive ASI before starting SU and those who received ASI during SU treatment. CONCLUSION Concomitant use of ASI may significantly improve OS and PFS in mRCC patients receiving SU. HTN is marginally associated with the outcome in these patients. |
Databáze: | OpenAIRE |
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