Use of inhibitors of the renin-angiotensin system is associated with longer survival in patients with hepatocellular carcinoma

Background: Inhibition of the renin-angiotensin system (RAS) was associated with longer survival in patients with different solid malignancies. Objective: The objective of this study was to investigate the effect of RAS inhibitor (RASi) treatment (angiotensin-converting enzyme inhibitors or angiotensin-II-receptor blockers) on survival of patients with hepatocellular carcinoma (HCC). Methods: Patients diagnosed with HCC and Child-Pugh A between 1992 and 2013 who received sorafenib, experimental therapy, or best supportive care were eligible for the Vienna cohort. The Mainz cohort included patients with HCC and Child-Pugh A who received sorafenib treatment between 2007 and 2016. The association between RASi and overall survival (OS) was evaluated in univariate and multivariate analyses. Results: In the Vienna cohort, 43 of 156 patients received RASi for hypertension. RASi treatment was associated with longer OS (11.9 vs. 6.8 months (mo); p=0.014) and remained a significant prognostic factor upon multivariate analysis (HR=0.6; 95% CI 0.4-0.9; p=0.011). In subgroup analysis, patients treated with sorafenib plus RASi had better median OS (19.5mo) compared to those treated with either sorafenib (10.9mo) or RASi (9.7mo) alone (p=0.043). The beneficial effect of RASi on survival was confirmed in the Mainz cohort (n=76). Conclusion: RAS inhibition is associated with longer survival in HCC patients with Child-Pugh class A.