Does the Use of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers Improve Survival in Bladder Cancer?

Abstract

Introduction: The use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) has been associated with improved bladder cancer outcomes. The objective of this study was to perform a systematic review of the literature and investigate the effects of these medications on survival from our own retrospective database. Methods: A systematic literature search of PubMed and the Cochrane database was conducted and 34 relevant articles identified. No randomised control trials were identified. After exclusion, five observational studies were included in our analysis. Since there was a paucity of data, we then performed a retrospective cohort study using clinical data from our electronic medical record. All patients who underwent radical cystectomy, with or without adjuvant chemotherapy, at a single tertiary care centre in Ontario, Canada between 2001 and 2016 were identified. Results: Our literature review found that ACEI or ARB use in upper urinary tract and lower urinary tract non-muscle invasive bladder cancer was associated with increased 5-year recurrence-free, cancer-specific, and overall survival. Our own analysis identified 464 patients who underwent radical cystectomy for muscle-invasive bladder cancer during the study period. Ninety-nine individuals received ACEI or ARB treatment during this time. Cox-proportion hazards modelling suggested that the use of ACEI or ARB was not significantly associated with a survival benefit. Conclusions: We are unable to support or oppose the use of ACEI or ARB as adjuvant treatment in bladder cancer due to the heterogeneity and quality of published data. Our own study data do not support the use of these medications as adjuvant therapy for muscle-invasive bladder cancer. A randomised control trial in this area of research is required.