Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2019; 25(20): 2524-2538
Published online May 28, 2019. doi: 10.3748/wjg.v25.i20.2524
Systematic review: Renin-angiotensin system inhibitors in chemoprevention of hepatocellular carcinoma
Michele Barone, Maria Teresa Viggiani, Giuseppe Losurdo, Mariabeatrice Principi, Alfredo Di Leo
Michele Barone, Maria Teresa Viggiani, Giuseppe Losurdo, Mariabeatrice Principi, Alfredo Di Leo, Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari 70124, Italy
Author contributions: Barone M and Di Leo A conceived and planned the study. Viggiani MT, Barone M, Losurdo G and Principi M collected the data. Barone M and Losurdo G wrote the manuscript. Viggiani MT and Principi M revised the draft. All authors read and approved the final version of the manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants/patents received, or royalties).
PRISMA 2009 Checklist statement: The manuscript was prepared according to the PRISMA 2009 Checklist.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Michele Barone, MD, PhD, Adjunct Professor, Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Piazza Giulio Cesare 11, Bari 70124, Italy. michele.barone@uniba.it
Telephone: +39-80-5593514 Fax: +39-80-5593177
Received: January 23, 2019
Peer-review started: January 23, 2019
First decision: February 21, 2019
Revised: March 6, 2019
Accepted: March 24, 2019
Article in press: March 25, 2019
Published online: May 28, 2019
Core Tip

Core tip: All experimental studies strongly support the ability of renin-angiotensin system (RAS) inhibitors to counteract carcinogenesis essentially by inhibiting angiogenesis and possibly fibrogenesis in chemically-induced or xeno-transplanted hepatocarcinomas, whereas additional pathogenetic mechanisms using animal models that mimic the progression of liver disease in humans and have been barely considered. In all randomized clinical trials, RAS inhibitors - in combination with other therapies - significantly reduced cumulative hepatocarcinoma recurrence. However, the data on patient survival obtained by these studies and several observational studies are not conclusive. The beneficial effect of the early use of RAS inhibitors on the progression of cirrhosis toward hepatocarcinoma cannot be excluded.