OBJECTIVES : Acid-suppressive agents are commonly administered among cancer patients because of the high prevalence of gastroesophageal reflux disease and peptic ulcer disease. The systematic review of the association between acid-suppressive agent use and survival outcomes in patients with cancer was conducted.

METHODS : We searched MEDLINE, EMBASE, and the Cochrane Library through December 2019. All randomized controlled trials (RCTs), quasi-RCTs, and observational studies on the impact of acid-suppressive agents having comparators reported progression-free survival (PFS) and/or overall survival (OS) were included. Baseline characteristics and survival outcomes were extracted. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using the random-effects model. Heterogeneity was assessed with I² statistic.

RESULTS A total of 45,626 patients from 7 RCTs and 18 observational studies including esophageal/gastric, colorectal, pancreatic, lung, breast, prostate, kidney, and other cancer were included. Five studies with 7,974 acid-suppressive agent users and 6,114 nonusers showed that acid-suppressive agent use in patients with lung cancer had a significant poor PFS (HR 1.64, 95% CI 1.14-2.37, I²=57%) and OS (HR 1.13, 95% CI 1.05-1.21, I²=0%) compared to nonusers. Each five studies did not find a significant association between acid-suppressive agents and OS in esophageal/gastric (HR 0.91, 95% CI 0.77-1.09, I²=32%) or colorectal cancer patients (HR 1.25, 95% CI 0.92-1.71, I²=0%). Acid-suppressive agent use was not significantly associated with OS in patients with kidney cancer compared to nonusers (HR 1.04, 95% CI 0.96-1.13, I²=28%).

CONCLUSIONS : The meta-analysis showed that acid-suppressive agents for survival in lung cancer patients was significantly decreased compared to nonusers, but there was no significant association in patients with esophageal/gastric, colorectal, and kidney cancer. Although the number of studies in this meta-analysis was limited, the use of acid-suppressive agents should be careful with lung cancer patients.