| Background/Aims:1.Evaluate the effects of angiotensin-converting enzyme inhibitor and angiotensin ? receptor inhibitor on chemotherapy efficacy of patients with gastric malignant tumor complicated with hypertension.2.Evaluate the effects of angiotensin-converting enzyme inhibitor and angiotensin ? receptor inhibitor on chemotherapy of patients with postoperative gastrointestinal malignant tumor complicated with hypertension 3.Evaluate the effects of angiotensin-converting enzyme inhibitor and angiotensin ? receptor inhibitor on chemotherapy and prognosis of patients with advanced gastrointestinal malignant tumor complicated with hypertension.4.Evaluate the effects of adverse reactions on chemotherapy efficacy of patients with gastric malignant tumor complicated with hypertension.Methods:Part one:The clinical data of 381 patients of gastric cancer complicated with hypertension was retrospectively collected in Zhejiang cancer hospital between January 1,2009 and December 31,2011.The studied group was treated with ACEI/ARBs antihypertensive drugs(n=75),while the control group was treated with Non-ACEI/ARBs antihypertensive drugs(n=306),both groups were followed up for survival.Statistical software 22.0 was used,and chi-square test was used to evaluate whether there is a significant statistical difference.Kaplan-Meier survival analysis was performed to determine the effects of ACEI/ARBs on the prognosis of patients with gastric malignant tumor complicated with hypertension.Part two:Subgroup Analysis was carried out on 257 patients of advanced gastric cancer complicated with hypertension in Zhejiang cancer hospital from January 1,2009 to December 31,2011.The studied group was treated with ACEI/ARBs antihypertensive drugs(52 cases),while the control group was treated with Non-ACEI/ARBs antihypertensive drugs(n=205),both groups were followed up for survival.The sex,age,family history,drinking history,PS score,BMI(body mass index),blood tumor index,smoking history,lymph node metastasis,invasion,pathological type,tumor staging,chemotherapy and tumor location of each group were statistically analyzed.Part three:Subgroup analysis was performed on 124 patients of advanced gastric malignant tumor hospitalized with hypertension in Zhejiang Cancer Hospital from January 1,2009 to December 31,2011.The standard and statistical methods are the same as part one.Statistics was performed using the 22.0 statistical software,the statistical difference between two groups was evaluate by chi-square test.Survival analysis was performed according to Kaplan-Meier,and COX regression was used to determine the prognostic value of ACEI/ARBs drugs in patients of advanced gastric cancer complicated with hypertension.Subgroup analysis was carried out on 23 patients of advanced gastric cancer with hypertension and ACE inhibitors/ARBs.Statistical analysis was performed using statistical software 22.0.Kaplan-Meier survival analysis was used to evaluate whether there is a significant statistical difference and to determine the survival effects of different factors on patient of advanced gastric cancer combined with hypertension using ACEI/ARB.Part four:Retrospective analysis was carried out to evaluate the adverse reactions on the hospitalized patients in Zhejiang Cancer Hospital from January 1,2009 to December 31,2011.Gastrointestinal reactions,diarrhea,nerve toxicity,myelosuppression,and fatigue of patients with chemotherapy efficacy and prognosis were statistically analyzed to evaluate the adverse reactions using ACEI/ARBs antihypertensive drugs and Non-ACEI/ARBs antihypertensive drugs.Results:Part one:There is no significant difference in,gender,age,PS score,BMI,blood tumor markers,smoking history,lymphatic metastasis,invasion levels,pathological types,tumor staging,and tumor of patients with gastric malignancy and hypertension except to family(P=0.02)and drinking history(P=0.03).The median survival time of patients with ACEI/ARBs was 1994 days,and patients without ACEI/ARBs was 1954 days,there is no significant survival difference between the two groups(P=0.074).Part two:there is no significant difference in the gender,age,drinking history,PS score,BMI,hematological tumor index,smoking history,lymphatic metastasis,invasion level,pathological types,tumor stage and tumor location of between the two groups except for the family history of the disease(P=0.001).The 3-year and the 5-year survival rate of the ACEI/ARBs group were 78.0%and 72.2%,respectively,while the 3-year and the 5-year survival rate of non-ACEI/ARBs group were 76.9%and 71.2%,respectively.There was no significant difference between the two groups.Part three:there is no significant difference of patients with advanced malignant tumor of stomach and hypertension in gender,age,family history of disease,PS score,BMI,blood index,smoking history,lymphatic metastasis,level of invasion,pathological type,tumor stage,and tumor site except the alcohol history(P=0.042).The effective rate of first-line chemotherapy of ACEI/ARBs group was 73.9%,while the Non-group ACEI/ARBs group was 41.6%,therefore,there is a significant difference(P=0.016)between the two groups.However,the 1-and 3-year survival rate of the two groups has no significant difference statistical.The median survival time of the ACEI/ARBs group and Non-ACEI/ARBs group was 669 and 537 days,respectively.There was a significant statistical difference of survival time between the two groups(P=0.04).The COX regression analysis indicated that there are effects of first-line chemotherapy on the survival of patients treated with different antihypertensive drugs(P=0.001).Subgroup analysis was carried out to evaluate the effects of different factors on the survival rate of patients with advanced gastric cancer complicated with hypertension using ACEI/ARBs.There were no statistical difference between the studied group and the control group in t smoking(P=0.353),family history of cancer(P=0.271),family history of the disease(P=0.544),different tumor markers CEA(P=0.664),surgery(P=0.387)and gender(P=1.0),however there is statistical difference between the studied group and the control group in drinking(P=0.009),PS score(P=0.007),different pathological stage(P=0.015),different number of lymph node metastasis(P=0.001),whether there is distant metastasis(P=1×10-5)and clinical stage(P=0.04).Part four:As the experiment was retrospective analysis,the adverse reactions of 193 postoperative patients were collected,of which the highest rate is gastrointestinal reaction(72.0%),then bone marrow suppression(53.4%),diarrhea(35.7%),neurotoxicity(17.5%)and fatigue(16.6%).The adverse reactions of 96 patients with advanced cancer patients were collected,of which the highest rate is gastrointestinal reactions(85.5%),then bone marrow suppression(75.0%),diarrhea(45.8%),neurotoxicity(18.8%),and fatigue(22.9%).Statistical analysis indicated that FOLFOX?XELOX?SOX chemotherapy regimens may cause ? to ? adverse reactions and the patients were well tolerated.Conclusions:Part one:There was no significant difference between the ACEI/ARBs group and non-ACEI/ARBs group of patients with gastric cancer complicated with hypertension(P=0.74).Part two:There was no significant difference of 3-year and 5-year survival rare between ACEI/ARBs and non-ACEI/ARBs antihypertensive drugs of postoperative gastric cancer patients with hypertension.Part three:ACEI/ARBs can improve the effects of first-line chemotherapy(73.9%VS 41.6%,P=0.016)and prolong the survival time(median survival time of 669 days VS 537 days,P=0.04)of patients with hypertension complicated with advanced gastric malignant tumors.Smoking,family history of cancer,family history of the disease,different tumor markers CEA,surgical and gender have no effects on the survival of patients with advanced gastric malignant tumor complicated with hypertension using ACEI/ARBs.Drinking,PS score,different pathological stages,different number of lymph node metastasis,whether distant metastasis,staging of patients have significant effects on clinical survival of patients advanced gastric cancer with hypertension using ACEI/ARBs.Part four:?-?adverse reactions are rarely caused by FOLFOX?XELOX?SOX chemotherapy,the patients were well tolerated and can complete all the planed chemotherapy cycles. |
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