MP26-08 RENIN-ANGIOTENSIN INHIBITORS DECREASE RECURRENCE AFTER TURBT IN NON-MUSCLE INVASIVE BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive I1 Apr 2015MP26-08 RENIN-ANGIOTENSIN INHIBITORS DECREASE RECURRENCE AFTER TURBT IN NON-MUSCLE INVASIVE BLADDER CANCER Michael L. Blute, Timothy J. Rushmer, Fangfang Shi, Benjamin Fuller, E. Jason Abel, David F. Jarrard, and Tracy M. Downs Michael L. BluteMichael L. Blute More articles by this author , Timothy J. RushmerTimothy J. Rushmer More articles by this author , Fangfang ShiFangfang Shi More articles by this author , Benjamin FullerBenjamin Fuller More articles by this author , E. Jason AbelE. Jason Abel More articles by this author , David F. JarrardDavid F. Jarrard More articles by this author , and Tracy M. DownsTracy M. Downs More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1130AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prior reports have suggested that inhibition of the renin-angiotensin system (RAS) may decrease recurrence of non-muscle invasive bladder cancer (NMIBC). The purpose of this study was to evaluate if treatment with ACE-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) at initial surgery was associated with decreased recurrence or progression in NMIBC patients. METHODS An institutional bladder cancer database identified 340 patients with data available for initial TURBT. Progression was defined as an increase to stage T2. Cox proportional hazards models were used to evaluate associations with recurrence-free (RFS) and progression-free survival (PFS). RESULTS Median patient age was 69.6. Median follow-up was 3 years (IQR 1.3-6.1), 200 (59%) patients had a recurrence and 14 (4.1%) had stage progression. Of those, 143 patients were taking ACE-I/ARB at the time of their first TUR. On univariate analysis, factors associated with improved RFS included presence of CIS (p=0.040), bacillus Calmette-Guerin (BCG) therapy (p=0.003), and ACE-I/ARB therapy (p=0.009). Multivariate analysis demonstrated that patients treated with BCG therapy (HR 0.68, 95% CI 0.47-0.87; p=0.002) or ACE-I/ARB therapy (HR 0.61, 95% CI 0.45-0.84; p=0.005), were less likely to experience tumor recurrence. The 5-year RFS rate was 45.6% for patients treated with ACE-I/ARBs and 28.1% for patients not treated with ACE-I/ARBs (p=0.009). Subgroup analysis was performed evaluating patients on BCG therapy alone (n=85) and combined with ACE-I/ARB therapy (n=52) on NMIBC pathology (Ta, T1, CIS). Multivariate analysis revealed that patients treated with BCG alone (HR 2.19, 95% CI 1.01-4.77; p=0.04) were associated with a worse RFS compared to patients treated with BCG and ACE-I/ARB therapy (HR 0.45, 95% CI 0.21-0.98; p=0.04) for stage Ta. CONCLUSIONS Pharmacologic inhibition of RAS is associated with improved outcomes in bladder cancer patients. RAS inhibitor administration in NMIBC should be studied in a prospective randomized trial. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e296 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael L. Blute More articles by this author Timothy J. Rushmer More articles by this author Fangfang Shi More articles by this author Benjamin Fuller More articles by this author E. Jason Abel More articles by this author David F. Jarrard More articles by this author Tracy M. Downs More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...