Siriraj Medical Journal (Jan 2019)

Administration of Renin-Angiotensin System Inhibitor Affects Tumor Recurrence and Progression in Non-Muscle Invasive Bladder Cancer Patients

  • Saran Maneesuwansin, M.D.,
  • Chalairat Suk-ouichai, M.D.,
  • Patkawat Ramart, M.D.,
  • Siros Jitpraphai, M.D.,
  • Kittipong Phinthusophon, M.D.,
  • Ekkarin Chotikawanich, M.D.,
  • Teerapon Amornvesukit, M.D.,
  • Tawatchai Taweemonkongsap, M.D.,
  • Bansithi Chaiyaprasithi, M.D.,
  • Sunai Leewansangtong, M.D.,
  • Sittiporn Srinualnad, M.D.,
  • Chaiyong Nualyong, M.D.

DOI
https://doi.org/10.33192/Smj.2019.06
Journal volume & issue
Vol. 71, no. 1
pp. 31 – 37

Abstract

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Objective: To evaluate the effects of renin-angiotensin system inhibitors (RASIs) on tumor-recurrence and disease-progression in non-muscle invasive bladder cancer (NMIBC) patients. Methods: From 2006-2015, 348 NMIBC patients at Siriraj Hospital were recruited for this study. Tumor-recurrence was identified after the transurethral resection of bladder cancer (TUR-BT) and pathological confirmation of NMIBC, while stage-progression was defined as muscularis-propria invasion after pathological review or metastases. Cox proportional hazards models were used to assess the recurrence-free survival (RFS) and progression-free survival (PFS) rates. Results: Of the 348 patients, 86 (24.7%) received RASIs at the first TUR-BT. The median age was 68 years, and it was significantly older for the RASI cohort. No differences in the tumor characteristics of the groups were found. The median follow-up periods for tumor-recurrence and stage-progression were 2.3 and 3.7 years, respectively. Forty percent of the patients experienced tumor-recurrence, with the no-RASI cohort experiencing a significantly higher tumor-recurrence rate (46% versus 22%, p<0.001). The 5-year RFS rates were 54% and 78% for the no-RASI and RASI cohorts, respectively (p=0.001). Stage-progression was observed in 6% of the patients. The 5-year PFS rates were 87% and 97% for the no-RASI and RASI cohorts, respectively. On univariate and multivariate analyses, a tumor size ≥3 cm and tumor multifocality were associated with recurrent bladder cancer (p<0.02). On the other hand, the administration of RASIs was associated with a reduced recurrence (p≤0.002). Conclusion: Our study suggests that RASI administration might be a potential factor to prevent bladder cancer recurrence. Further study is needed to evaluate the effects of RASIs.

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