硬膜外镇痛与传统疼痛管理对胃癌切除术后结局影响的比较：一项基于人群的研究。
A comparison of the effects of epidural analgesia versus traditional pain management on outcomes after gastric cancer resection: a population-based study.
机构信息
From the *Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic; †Department of Epidemiology and Biostatistics, Case Western Reserve University; ‡Division of Gastroenterology and Liver Disease, University Hospitals Case Medical Center; and §Department of Epidemiology and Biostatistics, School of Medicine, and Case Comprehensive Cancer Center, Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, OH.
出版信息
Reg Anesth Pain Med. 2014 May-Jun;39(3):200-7. doi: 10.1097/AAP.0000000000000079.
BACKGROUND AND OBJECTIVES
Epidural analgesia may increase survival after cancer surgery by reducing recurrence. This population-based study compared survival and treated recurrence after gastric cancer resection between patients receiving epidurals and those who did not.
METHODS
We used the linked federal Surveillance, Epidemiology, and End Results Program/Medicare database to identify patients aged 66 years or older with nonmetastatic gastric carcinoma diagnosed 1996 to 2005 who underwent resection. Exclusions included diagnosis at autopsy, no Medicare Part B, familial cancer syndrome, emergency surgery, and laparoscopic procedures. Epidurals were identified by Current Procedural Terminology codes. Treated recurrence was defined as chemotherapy greater than or equal to 16 months and/or radiation greater than or equal to 12 months after surgery. Recurrence was compared by conditional logistic regression. Survival was compared via marginal Cox proportional hazards regression model.
RESULTS
We identified 2745 patients, 766 of whom had epidural codes. Patients receiving epidurals were more likely to have regional disease, be white, and live in areas with relatively high socioeconomic status. Overall treated recurrence was 25.6% (27.5% epidural and 24.9% nonepidural). In the adjusted logistic regression, there was no difference in recurrence (odds ratio, 1.40; 95% confidence interval [CI], 0.96-2.05). Median survival did not differ: 28.1 months (95% CI, 24.8-32.3) in the epidural versus 27.4 months (95% CI, 24.8-30.0) in the nonepidural groups. The marginal Cox models showed no association between epidural use and mortality (adjusted hazard ratio, 0.93; 95% CI, 0.84-1.03).
CONCLUSIONS
There was no difference between groups regarding treated recurrence or survival. Whether this is true or simply a result of insufficient power is unclear. Prospective studies are needed to provide stronger evidence.
背景与目的
硬膜外镇痛可能通过降低复发率来提高癌症手术后的存活率。本基于人群的研究比较了接受硬膜外镇痛和未接受硬膜外镇痛的胃癌切除术后患者的生存和治疗后复发情况。
方法
我们使用联邦监测、流行病学和最终结果计划/医疗保险数据库，确定了 1996 年至 2005 年间诊断为非转移性胃癌且年龄在 66 岁或以上的接受切除术的患者。排除标准包括尸检诊断、没有医疗保险 B 部分、家族性癌症综合征、急诊手术和腹腔镜手术。硬膜外镇痛通过当前程序术语代码确定。治疗后复发定义为手术后 16 个月以上接受化疗和/或 12 个月以上接受放疗。通过条件逻辑回归比较复发情况。通过边缘 Cox 比例风险回归模型比较生存情况。
结果
我们确定了 2745 例患者，其中 766 例有硬膜外编码。接受硬膜外镇痛的患者更有可能患有区域性疾病，是白人，并且居住在社会经济地位相对较高的地区。总体治疗后复发率为 25.6%（硬膜外 27.5%，无硬膜外 24.9%）。在调整后的逻辑回归中，复发率无差异（比值比，1.40；95%置信区间 [CI]，0.96-2.05）。中位生存时间无差异：硬膜外组为 28.1 个月（95%CI，24.8-32.3），无硬膜外组为 27.4 个月（95%CI，24.8-30.0）。边缘 Cox 模型显示硬膜外使用与死亡率之间没有关联（调整后的危险比，0.93；95%CI，0.84-1.03）。
结论
两组之间在治疗后复发或生存方面没有差异。这是真实的还是仅仅是由于效力不足的结果尚不清楚。需要前瞻性研究提供更强有力的证据。
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