Identification of Optimal Baseline Blood Pressure Predicting Postoperative Digestive Tract Cancer-Specific Mortality in the FIESTA Cohort Involving 6865 Patients

Background and Objectives: Emerging evidence indicates that hypertension is a potential risk and prognostic factor for cancer at many sites. Currently, no data are available on optimal blood pressure target in patients with resectable digestive tract cancer. Here, we did an exploratory analysis in 6865 patients from the FIESTA cohort to identify optimal blood pressure at baseline that can better predict digestive tract cancer-specific mortality risk postoperatively. Methods and Results: Patients were enrolled between January 2000 and December 2010, with follow-up ending in December 2015. All patients received no preoperative and postoperative chemotherapy or radiotherapy. Data were analyzed using Stata software and R language. Optimal cutting points were determined using survival tree analysis. After a median follow-up of 44.9 months, there were 2808 non-survivors and 4057 survivors. Per 10 mm Hg increment, baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure and mean arterial pressure were associated with the significant risk of digestive tract cancer-specific mortality, even after adjusting for confounding factors (adjusted hazard ratio: 1.06, 1.08, 1.06 and 1.09, 95% confidence interval: 1.04-1.08, 1.04-1.12, 1.03-1.09 and 1.05-1.12, P<0.001, <0.001, <0.001 and <0.001, respectively). Patients with baseline SBP of 176 mm Hg or above and DBP of 100 mm Hg or above had poor survival outcomes (median survival time: 39.6 and 37.1 months, respectively). Conclusions: We provide evidence for the use of elevated blood pressure (SBP/DBP ≥176/100 mm Hg) before surgery as a powerful harbinger to predict the survival outcomes of digestive tract cancer patients postoperatively.