title: The renin-angiotensin system blockers as adjunctive therapy for cancer: a meta-analysis of survival outcome.
abstract: The renin-angiotensin system blockers (RASBs), including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), are widely used to reduce cardiovascular disease (CVD) events. Accumulating pre-clinical and clinical studies suggested that RASBs possesses anti-carcinogenic properties, and their use is associated with favorable outcomes in several type cancers. To conduct a meta-analysis to evaluate the effect of adjunctive therapy of renin-angiotensin system blockers combined with chemotherapeutic agents in cancer patients.
  
  
  
  Data from a total of 2436 patients from 7 retrospective studies investigating chemotherapeutic agents in combination with RASBs agents versus chemotherapeutic agents were included in this meta-analysis. Publication bias was assessed by the Begg's Test, Egger's test and funnel plot. Subgroup analysis was conducted when the chemotherapeutic agents were the same.
  
  
  
  A signiﬁcant reduction in overall mortality in favor of chemotherapeutic agents in combination with RASBs agents was observed, hazard ratio (HR) 0.80 (95% CI: 0.69-0.92); there was a signiﬁcant decrease in the risk of disease progression in favor of chemotherapeutic agents in combination with RASBs regimens, HR 0.79 (95% CI: 0.66-0.94), compared with those who only used chemotherapeutic agents. Subgroup analysis indicated that platinum-based agents plus ACEI/ARB could increase significantly the survival outcome (HR = 0.56; 95% CI: 0.38-0.82).
  
  
  
  Our results suggest that RASBs combined with chemotherapeutic agents may improve outcomes in multiple types' cancer patients. More research and well-designed, rigorous, large clinical trials are required to address these issues.
authors.affiliation: Medical Faculty of Kunming University of Science and Technology, Kunming, China. lixying98@163.com.
authors.forename: X-Y
authors.initials: XY
authors.lastname: Li
authors.forename: J-F
authors.initials: JF
authors.lastname: Sun
authors.forename: S-Q
authors.initials: SQ
authors.lastname: Hu
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors