Association of perioperative blood pressure with long-term survival in rectal cancer patients.

Hui-Chuan Yu,Jian-Ping Wang,Lei Wang,Hui Peng,Mei-Jin Huang,Liang Kang,Xiao-Lin Wang,Yan-Xin Luo,Zi-Huan Yang

doi:10.1186/s40880-016-0100-8

Abstract

BackgroundSeveral studies suggested that hypertension is positively related to cancer incidence and mortality. In this study, we investigated the association between perioperative blood pressure (BP) and long-term survival outcomes in patients with rectal cancer.MethodsThis study included a cohort of 358 patients with stages I–III rectal cancer who underwent a curative resection between June 2007 and June 2011. Both pre- and postoperative BPs were measured, by which patients were grouped (low BP: <120/80 mmHg; high BP: ≥120/80 mmHg). The survival outcomes were compared between these two groups. The primary endpoints were disease-free survival (DFS) and cancer-specific survival (CSS).ResultsUnivariate analysis showed that patients with high preoperative systolic BP had lower 3-year DFS (67.2% vs. 82.1%, P = 0.041) and CSS rates (81.9% vs. 94.8%, P = 0.003) than patients with low preoperative systolic BP, and the associations remained significant in the Cox multivariate analysis, with the adjusted hazard ratios equal to 1.97 [95% confidence interval (CI) = 1.08–3.60, P = 0.028] and 2.85 (95% CI = 1.00–8.25, P = 0.050), respectively. Similarly, in postoperative evaluation, patients with high systolic BP had significantly lower 3-year CSS rates than those with low systolic BP (78.3% vs. 88.9%, P = 0.032) in univariate analysis. Moreover, high pre- and/or postoperative systolic BP presented as risk factors for CSS in the subgroups of patients who did not have a history of hypertension, with and/or without perioperative administration of antihypertensive drugs.ConclusionsHigh preoperative systolic BP was an independent risk factor for both CSS and DFS rates, and high postoperative systolic BP was significantly associated with a low CSS rate in rectal cancer patients. Additionally, our results suggest that rectal cancer patients may get survival benefit from BP control in perioperative care. However, further studies should be conducted to determine the association between BP and CSS and targets of BP control.

Highlights

Several studies suggested that hypertension is positively related to cancer incidence and mortality
Our study showed that perioperative blood pressure (BP) is negatively associated with survival outcome in patients with rectal cancer
Our results indicate that the cancer-specific death risk of high systolic blood pressure (SBP) is higher and statistically significant in men and in patients with a low body mass index (BMI), which is consistent with the findings from previous study of all-site cancer and colorectal cancer [6]

Summary

Introduction

Several studies suggested that hypertension is positively related to cancer incidence and mortality. Additional studies have shown that colorectal cancer risk is positively related to elevated blood pressure (BP) [8,9,10,11,12]. These findings were inconsistent, and in previous studies patients’ BP was measured only at the time of baseline health examination. Existing data are hampered by lack of adjustment for some potential confounding factors, such as tumor stage, tumor location, and the tumor’s histologic features Against this background of inconsistent results and study limitations, we extended these findings by examining the association of perioperative BP with long-term survival outcomes in rectal cancer patients treated with radical-intent surgery. If a positive association does exist, efforts to control BP in perioperative care may lead to extended survival for these patients, which may in turn reveal new therapeutic targets and prognostic biomarkers

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Results

Discussion

Conclusion