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

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


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.


Non-muscle invasive bladder cancer; renin-angiotensin system inhibitors; tumor recurrence; stage progression

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