Incidental use of angiotensin system inhibitors during neoadjuvant chemotherapy for ESCC was associated with improved overall survival (HR 0.48; 95% CI 0.29-0.79; p=0.004) and higher MPR (31.3% vs 17.0%).
Cohort (n=391)
Does incidental use of angiotensin system inhibitors improve survival and pathological response in patients with esophageal squamous cell carcinoma undergoing neoadjuvant chemotherapy?
Incidental use of angiotensin system inhibitors during neoadjuvant chemotherapy for esophageal squamous cell carcinoma is associated with improved pathological response and long-term survival.
Effect estimate: HR 0.48 (95% CI 0.29-0.79)
p-value: p=0.004
Background: The renin–angiotensin–aldosterone system (RAAS) is implicated in the initiation, progression, and therapeutic response of several solid malignancies. RAAS inhibitors (angiotensin system inhibitors) exhibit potential antitumor effects; however, their impact on patients with esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant therapy remains scarce. Objectives: To investigate whether incidental ASI use during neoadjuvant treatment is associated with enhanced pathological response and survival outcomes in patients with ESCC. Design: A retrospective study. Methods: We retrospectively analyzed 391 ESCC patients who underwent neoadjuvant therapy followed by R0 resection between 2015 and 2022, stratified according to incidental use of ASIs during neoadjuvant chemotherapy (NAC). Baseline characteristics, major pathologic response (MPR), and long-term survival outcomes were compared. MPR rates were compared using the Chi-square test and multivariable logistic regression. Kaplan–Meier analysis was used to estimate overall survival (OS) and disease-free survival (DFS), and multivariable Cox proportional hazards models were applied to adjust for potential confounders. Sensitivity analyses were performed using propensity score matching (PSM). Results: Overall, 67 (17.1%) patients were administered ASIs. Compared with non-users, ASI users were older ( p = 0.006) with a higher prevalence of hypertension ( p < 0.001), while other characteristics were comparable. Overall, ASI use was significantly associated with improved OS (hazard ratio (HR) = 0.48, 95% confidence interval (CI): 0.29–0.79, p = 0.004) and DFS (HR = 0.56, 95% CI: 0.36–0.90, p = 0.015). The MPR rate was also higher in the ASI group (31.3% vs 17.0%, p = 0.007) and consistent with the results of the multivariable analysis (odds ratio = 2.19, 95% CI: 1.21–3.97, p = 0.010). After PSM, the survival benefit of ASI use remained significant for OS (HR = 0.38, p = 0.003) and DFS (HR = 0.54, p = 0.038). Conclusion: In ESCC patients receiving NAC, incidental ASI use correlated with better pathological response and improved long-term survival. RAAS inhibition shows promise as a perioperative therapeutic approach and warrants postoperative validation.
Chen et al. (Fri,) conducted a cohort in Esophageal squamous cell carcinoma (n=391). Angiotensin system inhibitors (ASIs) vs. Non-users was evaluated on Overall survival (HR 0.48, 95% CI 0.29-0.79, p=0.004). Incidental use of angiotensin system inhibitors during neoadjuvant chemotherapy for ESCC was associated with improved overall survival (HR 0.48; 95% CI 0.29-0.79; p=0.004) and higher MPR (31.3% vs 17.0%).