Impact of angiotensin system inhibitors on esophageal cancer survival

Xuanji Wang, MD; Patrick Sweigert, MD, MS; Emanuel Eguia, MD, MS; M. Alyssa Varsnik, MD; Christen R. Renz, MD; Weston A. Terrasse, MD; Madeline Gauthier, BA; Gerard Aranha, MD; Lawrence M. Knab, MD; Gerard Abood, MD

Surgery Open Science (Jan 2021)

Impact of angiotensin system inhibitors on esophageal cancer survival

Xuanji Wang, MD,
Patrick Sweigert, MD, MS,
Emanuel Eguia, MD, MS,
M. Alyssa Varsnik, MD,
Christen R. Renz, MD,
Weston A. Terrasse, MD,
Madeline Gauthier, BA,
Gerard Aranha, MD,
Lawrence M. Knab, MD,
Gerard Abood, MD

Affiliations

Xuanji Wang, MD: Corresponding author at: Loyola University Medical Center, Department of Surgery, 2160 S First Ave, Maywood, IL 60153.; Department of Surgery, Loyola University Medical Center, Maywood, IL
Patrick Sweigert, MD, MS: Department of Surgery, Loyola University Medical Center, Maywood, IL
Emanuel Eguia, MD, MS: Department of Surgery, Loyola University Medical Center, Maywood, IL
M. Alyssa Varsnik, MD: Department of Surgery, Loyola University Medical Center, Maywood, IL
Christen R. Renz, MD: Department of Surgery, Loyola University Medical Center, Maywood, IL
Weston A. Terrasse, MD: Department of Surgery, Loyola University Medical Center, Maywood, IL
Madeline Gauthier, BA: Department of Surgery, Loyola University Medical Center, Maywood, IL
Gerard Aranha, MD: Department of Surgery, Loyola University Medical Center, Maywood, IL
Lawrence M. Knab, MD: Department of Surgery, Loyola University Medical Center, Maywood, IL
Gerard Abood, MD: Department of Surgery, Loyola University Medical Center, Maywood, IL

Journal volume & issue: Vol. 3
pp. 34 – 38

Abstract

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Introduction: Angiotensin system inhibitors are associated with improved prognosis in patients with gastrointestinal and hepatobiliary cancers. Data suggest that renin–angiotensin system signaling stimulates the tumor's immune microenvironment to impact overall survival. The goal of this study is to investigate the role of angiotensin system inhibitor use on the overall survival and disease-free survival of esophageal cancer patients. Methods: Retrospective review of esophagectomy patients with esophageal adenocarcinoma and squamous cell cancer at a single institution tertiary care center from 2007 to 2018 was performed. Outcomes include overall survival and disease-free survival. Patient characteristics were compared with t test and χ2 test. Survival was analyzed with Kaplan–Meier and Cox proportional-hazards regression. Results: One hundred seventy-one patients were identified and 123 underwent esophagectomy for cancer. No significant differences in patient demographics were found between angiotensin system inhibitor users and non–angiotensin system inhibitor users except for the rates of hypertension (40% vs 94%, P < .01) and diabetes (16% vs 47%, P < .01). Distributions of tumor neoadjuvant therapy, adjuvant therapy, pathology, staging, margins, and surgical approach were similar. Postoperatively, there was no difference in major adverse cardiovascular events or infection rates. This study did not find any differences in overall survival and disease-free survival between angiotensin system inhibitor users and non–angiotensin system inhibitor users. Conclusion: Angiotensin system inhibitors have been shown to improve survival and decrease relative risk for several types of cancers; however, our data do not support the same effect on esophageal cancer patients undergoing curative intent surgery. Further research is needed to investigate potential nuances in angiotensin system inhibitor dose, chronicity of use, esophageal pathology, and applicability to nonsurgical candidates.

Published in Surgery Open Science

ISSN: 2589-8450 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/surgery-open-science/

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