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Beta-blocker use and urothelial bladder cancer survival: a Swedish register-based cohort study
Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Epidemiology and Biostatistics.ORCID iD: 0000-0001-9204-1165
Department of Research, Cancer Registry of Norway, Oslo, Norway.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Urology.ORCID iD: 0000-0003-4615-5238
Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.ORCID iD: 0000-0001-6328-5494
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2022 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 61, no 8, p. 922-930Article in journal (Refereed) Published
Abstract [en]

Background: Recent observational studies linked beta-adrenergic receptor blocker use with improved survival in patients with several cancer types, but there is no information on the potential effects of beta-blockers in patients with bladder cancer. Literature from pre-clinical studies is also limited, but urothelial cancer can exhibit significant overexpression of beta-adrenergic receptors relative to normal urothelial tissue, suggesting that urothelial cancer may benefit from beta-blockade therapy. We thus aimed to explore the possible association between beta-blocker use and bladder cancer-specific mortality (BCSM) among patients with urothelial bladder cancer.

Material and methods: Patients diagnosed during 2006-2014 and identified from the Swedish Cancer Register (n = 16,669) were followed until 31 December 2015. Cox regression was used to evaluate the association of beta-blockers dispensed within 90 days prior to cancer diagnosis with BCSM (primary outcome) and all-cause mortality, while controlling for socio-demographic factors, tumor characteristics, comorbidity, other medications and surgical procedures. Hazard ratios (HR) with 95% confidence intervals (CI) were reported.

Results: Overall, beta-blocker use was associated with lower BCSM [HR 0.88 (95%CI 0.81-0.96)]. Especially use of nonselective beta-blockers showed a clear inverse association in comparison with both nonuse [0.66 (0.50-0.86)] and use of other antihypertensive medications [0.72 (0.54-0.95)]. The inverse association was most pronounced among patients with locally advanced/metastatic disease: [0.35 (0.18-0.68)]. A lower-magnitude inverse association was observed for selective beta-blocker use [0.91 (0.83-0.99)]. Largely similar inverse associations were observed for hydrophilic [0.82 (0.70-0.95)] and lipophilic [0.91 (0.83-1.00)] beta-blocker use.

Conclusion: beta-blocker use, particularly of the nonselective type, was associated with lower BCSM, especially in patients with locally advanced/metastatic urothelial bladder cancer.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2022. Vol. 61, no 8, p. 922-930
Keywords [en]
Adrenergic signaling, beta-blocker, urothelial bladder cancer, survival, cohort study
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:oru:diva-100418DOI: 10.1080/0284186X.2022.2101902ISI: 000830641200001PubMedID: 35881046OAI: oai:DiVA.org:oru-100418DiVA, id: diva2:1685815
Funder
Swedish Cancer Society, CAN 2013/650Available from: 2022-08-05 Created: 2022-08-05 Last updated: 2024-10-09Bibliographically approved

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Udumyan, RuzanJerlström, TomasMontgomery, ScottFall, Katja

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