Table 1_Renin–angiotensin system inhibitor use and survival outcomes in lung cancer: a systematic review and meta-analysis.docx

RASi use was associated with longer overall survival (OS; HR = 0.76, 95% CI: 0.70–0.83; I² = 82.9%) and progression-free survival (PFS; HR = 0.79, 95% CI: 0.70–0.89; I² = 40.9%) in conventional random-effects meta-analyses. Subgroup analyses generally showed consistent associations across treatment modalities and geographic regions, although substantial heterogeneity remained in several subgroups.

Egger’s test indicated small-study effects for OS. Although the large-study restricted analysis remained significant (HR = 0.82, 95% CI: 0.74–0.90), PET-PEESE adjustment attenuated the estimate to the null (HR = 1.00, 95% CI: 0.95–1.05). No significant evidence of small-study effects was observed for PFS.</p>Conclusion<p>Conventional meta-analysis showed an association between RASi use and longer OS and PFS.

However, the OS association was attenuated to the null after adjustment for small-study effects, indicating that the magnitude and robustness of the observed OS association remain uncertain. These findings should therefore be interpreted cautiously and require confirmation in well-designed prospective studies.</p>Systematic Review Registration<p>crd.york.ac.uk/prospero/display_record.php?ID=CRD420251053671, identifier: CRD420251053671.</p>