A much-debated question is whether renin-angiotensin system inhibitors (RASi) have any beneficial effects in patients with HCC.
The present study did not prove a significant association between RASi use and HCC across the entire cohort.
The results of this study indicate lower HCC incidence with RASi use in some subgroups.
The RASi use significantly reduced the risk of HCC incidence in women, but not in men.
Angiotensin II receptor blockers had the greatest impact on lowering the risk of HCC incidence, compared with other types of RASi.
To date, there has been a renewed interest in renin-angiotensin system inhibitors (RASi) for HCC prevention because they may reduce potent angiogenic factors.
This study set out to investigate associations between RASi use and HCC development.
We conducted a nested case-control study. A case was defined as a patient who was newly diagnosed with HCC. We selected 567 cases and controls using 1:1 propensity score matching. RASi exposure was classified into ever-user and never-user, then categorized according to cumulative dose and prescription period. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for HCC incidence according to RASi use were analyzed.
Overall, no significant association was found between exposure to RASi and HCC incidence (ever-user vs. never-user: aOR, 0.77; 95% CI, 0.56−1.07). In subgroup analysis, women receiving RASi ≥30 cumulative defined daily doses (cDDDs) showed significantly lower aORs (0.49; 95% CI, 0.24−0.95. Angiotensin II receptor blockers only-use ≥30 cDDD was significantly associated with reduced risk of HCC (aOR, 0.65; 95% CI, 0.43−0.97). In cases where subjects did not have diabetes mellitus and where the cDDD of RASi was 1800 or more, the risk of HCC development was significantly reduced compared to that in subjects with no RASi exposure (aOR, 0.26; 95% CI, 0.08−0.72).
The present study did not verify a significant overall association between RASi use and HCC but indicated lower HCC incidence in some subgroups. The possibility of a beneficial effect at a higher cumulative RASi dose was also presented.Le texte complet de cet article est disponible en PDF.
Keywords : Renin-angiotensin system inhibitors, Angiotensin II receptor blockers, Hepatocellular carcinoma, Defined daily doses, Nested case-control study