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);  = 0.014) and remained a significant prognostic factor upon multivariate analysis (HR = 0.6; 95% CI 0.4-0.9;  = 0.011). In subgroup analysis, patients treated with sorafenib plus RASi had better median OS (19.5 mo) compared to those treated with either sorafenib (10.9 mo) or RASi (9.7 mo) alone ( = 0.043). The beneficial effect of RASi on survival was confirmed in the Mainz cohort ( = 76).

Conclusion: RAS inhibition is associated with longer survival in HCC patients with Child-Pugh class A.