• prognostic factor
• predictive factor
• mRCC
• renal cell carcinoma
• hypertension
• sunitinib

Purpose
Hypertension (HTN), one of the most frequent side effects of VEGF inhibitors, has been related with outcome in mRCC. We aimed to investigate the association between HTN, Angiotensin System Inhibitors (ASI) use and survival outcomes in patients (pts) with mRCC treated with sunitinib (SU).
Methods
We retrospectively reviewed 213 pts with mRCC who received SU as first line treatment from April 2004 to November 2013. Baseline HTN (diagnosis and treatment before SU), use of ASI (either before or during SU) were analysed, and outcome (PFS, OS and response rate) of the different subgroups were compared. Survivals were compared with log-rank test and hazard ratios (HR) and 95% confidence interval (CI) through a multivariable Cox model adjusted on important covariables.
Results
88 (41%) baseline hypertensive pts tended to have longer OS (median: 33 vs 23 months, p=0.003) and longer PFS (median: 12 vs 9 months, p<0.002) than 125 pts (59%) who were not baseline hypertensive. Pts who used ASI (n=105) had more baseline HTN (65 vs 19%, p<.001) and they were compared with pts (n=108) who did not. Pts ASI user had a longer OS (median: 44 vs 18 months, p<0.001) and PFS (median: 15 vs 7 months, p<0.001) when compared to non ASI user. Among ASI users, OS and PFS were not significantly different between ASI users before SU and ASI users during SU.
Conclusion
In this study, we demonstrated that baseline HTN is an independent prognostic factor of outcome in mRCC pts receiving SU. In addition, concomitant use of ASI (before or during SU) may significantly improve OS and PFS in these patients. There is no difference on outcome between pts who receive ASI before starting SU and those who received ASI during SU treatment.