Retrospective target trial emulation of efficacy of renin-angiotensin system inhibitors in patients with stage II-III colon cancer and hypertension

A retrospective cohort study using data from centers in Shanghai (China) emulated a hypothetical randomized trial to evaluated efficacy of renin-angiotensin system inhibitors (RASIs) on long-term oncologic outcomes in patients with resected stage II-III colon cancer and hypertension. Eligible patients were 1:1 propensity score-matched classified into the RASI group and the no-RASI group. The primary outcomes was 3-year disease-free survival (DFS) rate. From 2640 eligible patients, 2292 were included in the primary analysis: 1146 in the RASI group and 1146 in the no-RASI group. The median follow-up time was 46.3 months. The 3-year DFS rate was 83.4% in the RASI group versus 78.3% in the no-RASI group (HR 0.736; p=0.001). The RASI group also had a lower 3-year distant metastasis rate (15.6% versus 20.5%; HR 0.717; p<0.001) and higher 3-year overall survival rate (92.4% versus 89.6%; HR 0.682; p=0.001). The authors conclude that RASIs may improve the postoperative long-term oncologic outcomes among patients with stage II-III colon cancer and hypertension.