From the *Department of Anesthesiology and Pain Medicine and †Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; and ‡Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea.
Anesth Analg. 2017 Oct;125(4):1322-1328. doi: 10.1213/ANE.0000000000002342.
Postoperative analgesic methods are suggested to have an impact on long-term prognosis after cancer surgery through opioid-induced immune suppression. We hypothesized that regional analgesia that reduces the systemic opioid requirement would be related to lower cancer recurrence and higher overall survival compared to intravenous patient-controlled analgesia (PCA) for lung cancer surgery.
Records for all patients who underwent open thoracotomy for curative resection of primary lung cancer between 2009 and 2013 in a tertiary care hospital were retrospectively analyzed. Patients were divided by postoperative analgesic methods: PCA (n = 574), thoracic epidural analgesia (TEA, n = 619), or paravertebral block (PVB, n = 536). Overall and recurrence-free survivals were compared among 3 analgesic methods via a multivariable Cox proportional hazard model and a log-rank test after adjusting confounding factors using propensity score matching (PSM).
Analgesic method was associated with overall survival (P= .0015; hazard ratio against TEA [95% confidence intervals]: 0.58 [0.39-0.87] for PCA, 0.60 [0.45-0.79] for PVB). After confounder adjustment using PSM, PVB showed higher overall survival than PCA (log-rank P= .0229) and TEA (log-rank P= .0063) while PCA and TEA showed no difference (log-rank P= .6). Hazard ratio for PVB was 0.66 [0.46-0.94] against PCA and 0.65 [0.48-0.89] against TEA after PSM. However, there was no significant association between the analgesic methods and recurrence-free survival (P= .5; log-rank P with PSM = .5 between PCA and TEA, .5 between PCA and PVB, .1 between TEA and PVB).
Pain-control methods are not related to cancer recurrence. However, PVB may have a beneficial effect on overall survival of patients with lung cancer.
术后镇痛方法通过阿片类药物诱导的免疫抑制作用，被认为对癌症手术后的长期预后有影响。我们假设，与静脉患者自控镇痛（PCA）相比，减少全身阿片类药物需求的区域镇痛方法与肺癌手术后的癌症复发率降低和总生存率提高有关。
回顾性分析了 2009 年至 2013 年期间在一家三级保健医院接受开胸根治性切除术治疗原发性肺癌的所有患者的记录。根据术后镇痛方法将患者分为 PCA 组（n=574）、胸段硬膜外镇痛（TEA，n=619）或椎旁阻滞（PVB，n=536）组。通过多变量 Cox 比例风险模型和对数秩检验，在使用倾向评分匹配（PSM）调整混杂因素后，比较 3 种镇痛方法的总生存率和无复发生存率。
镇痛方法与总生存率相关（P=0.0015；PCA 对 TEA 的危险比[95%置信区间]：0.58[0.39-0.87]，PVB 为 0.60[0.45-0.79]）。使用 PSM 调整混杂因素后，PVB 的总生存率高于 PCA（对数秩 P=0.0229）和 TEA（对数秩 P=0.0063），而 PCA 和 TEA 之间无差异（对数秩 P=0.6）。PSM 后，PVB 与 PCA 和 TEA 的危险比分别为 0.66[0.46-0.94]和 0.65[0.48-0.89]。然而，镇痛方法与无复发生存率之间无显著相关性（P=0.5；PSM 对数秩 P 值为 PCA 与 TEA 之间为 0.5，PCA 与 PVB 之间为 0.5，TEA 与 PVB 之间为 0.1）。
疼痛控制方法与癌症复发无关。然而，PVB 可能对肺癌患者的总生存率有有益影响。
