title: The effect of renin-angiotensin-system inhibition on survival and recurrence of N3+ breast cancer patients.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the association between the rennin-angiotensin system (RAS) inhibition and the risk of breast cancer (BC) recurrence and progression in N3 positive patients.
  
  
  METHODS
  The medical records of patients treated for N3 positive BC in Hacettepe Cancer Institute between 2005 and 2012 were evaluated. Angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) users were defined as patients who took these medications for at least 6 months in no evidence of disease (NED) stage after the initial diagnosis. The primary and secondary outcome was disease-free survival (DFS) and overall survival (OS). Kaplan-Meier and Cox proportional hazard models were used.
  
  
  RESULTS
  A total of 218 pathologic N3 BC patients were included. Follow up ranged from 12 to 212 months (median 49.58). Thirty one patients used ACE inhibitors/ARBs. Univariate analysis showed BC recurrence was lower and OS was higher among patients who used ACE inhibitors/ ARBs, however without reaching statistical significance (p=0.38 and p=0.24, respectively). RAS inhibition was associated with reduced risk of pathologic N3 BC recurrence.
  
  
  CONCLUSIONS
  To the best of our knowledge this is the second study showing that the use of ACE inhibitors/ARBs may be effective in N3 BC. Because of the limited therapeutic options in BC, new drugs or new therapeutic modalities should be considered. In the future, studies with long-term follow-up may be helpful for their implication in clinical practice.
authors.affiliation: Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.
authors.forename: Taner
authors.initials: T
authors.lastname: Babacan
authors.forename: Ozan
authors.initials: O
authors.lastname: Balakan
authors.forename: Taha Y
authors.initials: TY
authors.lastname: Kuzan
authors.forename: Furkan
authors.initials: F
authors.lastname: Sarici
authors.forename: Emre
authors.initials: E
authors.lastname: Koca
authors.forename: Neyran
authors.initials: N
authors.lastname: Kertmen
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Petekkaya
authors.forename: Kadri
authors.initials: K
authors.lastname: Altundag
mesh_terms: D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000970:Antineoplastic Agents