Association Of ACEIs/ARBs With Digestive System Neoplasms: A Meta-analysis

Objective: To systematically review the association between angiotensin-converting enzyme inhibitors(ACEIs)/angiotensin receptor blockers(ARBs)therapy and digestive system neoplasms.Methods: PubMed,EMbase,The Cochrane Library,CNKI,WanFang Data,VIP and CBM databases were searched for studies about ACEIs/ARBs therapy and risk of digestive system neoplasms incidence or survival of digestive system neoplasms patients.And then screened the literature,extracted the data and evaluated the risk of bias of included studies,then meta-analysis was performed using Stata 12.0 software.Results: A total of 34 original articles including 50 studies met the inclusion criteria,23 of which(including 36 studies)were trials investigating the relationship between ACEIs/ARBs therapy and risk of digestive system neoplasms incidence,and the other 11 of which were studies evaluating the relationship between ACEIs/ARBs therapy and survival of digestive system neoplasms patients.The pooled results were as follows.(1)Meta-analysis of 36 studies indicated a 9% decrease in risk of digestive system neoplasms in ACEIs/ARBs group as compared with those in control group(OR=0.91,95%CI 0.85-0.98,P=0.008).Subgroup analysis of 18 studies showed a 7% decrease in risk of colorectal cancer in ACEIs/ARBs group as compared with those in control group(OR=0.93,95%CI 0.87-0.99,P=0.000),but there was no significant relationgship between ACEIs/ARBs therapy and risk of other digestive system neoplasms,such as liver cancer,gastric cancer and esophageal neoplasms.(2)Meta-analysis of 14 studies demonstrated ACEIs/ARBs application was associated with an improvement of survival in digestive system neoplasms(HR=0.79,95%CI 0.70-0.89,P=0.000).Subgroup analysis revealed improved survival both of colorectal cancer patients(HR=0.78 95%CI 0.64-0.96,P=0.017)and pancreatic cancer(HR=0.68,95%CI 0.48-0.96,P=0.030)in ACEIs/ARBs group compared to those in control group.Conclusions: Use of ACEIs/ARBs may reduce the risk of colorectal cancer,as well as improve the survival of patients with colorectal cancer and pancreatic cancer,but there is no significant relationgship between ACEIs/ARBs therapy and risk of other digestive system neoplasms,such as liver cancer,gastric cancer,esophageal neoplasms.