Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Medicine, Princess Margaret Hospital, Perth, WA, Australia.
The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Br J Anaesth. 2018 Jul;121(1):45-57. doi: 10.1016/j.bja.2018.03.024. Epub 2018 May 3.
The biological perturbation associated with psychological and surgical stress is implicated in cancer recurrence. Preclinical evidence suggests that beta-blockers can be protective against cancer progression. We undertook a meta-analysis of epidemiological and perioperative clinical studies to investigate the association between beta-blocker use and cancer recurrence (CR), disease-free survival (DFS), and overall survival (OS).
Databases were searched until September 2017, reported hazard ratios (HRs) pooled, and 95% confidence intervals (CIs) calculated. Comparative studies examining the effect of beta-blockers (selective and non-selective) on cancer outcomes were included. The Newcastle Ottawa Scale was used to assess methodological quality and bias.
Of the 27 included studies, nine evaluated the incidental use of non-selective beta-blockers, and ten were perioperative studies. Beta-blocker use had no effect on CR. Within subgroups of cancer, melanoma was associated with improved DFS (HR 0.03, 95% CI 0.01-0.17) and OS (HR 0.04, 95% CI 0.00-0.38), while endometrial cancer had an associated reduction in DFS (HR 1.40, 95% CI 1.10-1.80) and OS (HR 1.50, 95% CI 1.12-2.00). There was also reduced OS seen with head and neck and prostate cancer. Non-selective beta-blocker use was associated with improved DFS and OS in ovarian cancer, improved DFS in melanoma, but reduced OS in lung cancer. Perioperative studies showed similar variable effects across cancer types, albeit from a limited data pool.
Beta-blocker use had no evident effect on CR. The beneficial effect of beta-blockers on DFS and OS in the epidemiological or perioperative setting remains variable, tumour-specific, and of low-level evidence at present.
与心理和手术应激相关的生物学改变与癌症复发有关。临床前证据表明，β受体阻滞剂可能对癌症进展具有保护作用。我们对流行病学和围手术期临床研究进行了荟萃分析，以调查β受体阻滞剂的使用与癌症复发（CR）、无病生存（DFS）和总生存（OS）之间的关系。
检索数据库直至 2017 年 9 月，汇总报告的风险比（HR）及其 95%置信区间（CI）。纳入评估β受体阻滞剂（选择性和非选择性）对癌症结局影响的比较研究。使用纽卡斯尔-渥太华量表评估方法学质量和偏倚。
在 27 项纳入的研究中，有 9 项评估了非选择性β受体阻滞剂的偶然使用，10 项为围手术期研究。β受体阻滞剂的使用对 CR 没有影响。在癌症亚组中，黑色素瘤与改善的 DFS（HR 0.03，95%CI 0.01-0.17）和 OS（HR 0.04，95%CI 0.00-0.38）相关，而子宫内膜癌与 DFS（HR 1.40，95%CI 1.10-1.80）和 OS（HR 1.50，95%CI 1.12-2.00）相关。头颈部和前列腺癌的 OS 也降低。非选择性β受体阻滞剂的使用与卵巢癌的改善 DFS 和 OS、黑色素瘤的改善 DFS 相关，但与肺癌的 OS 降低相关。围手术期研究显示，不同癌症类型的结果存在差异，但数据有限。
β受体阻滞剂的使用对 CR 无明显影响。目前，β受体阻滞剂在流行病学或围手术期环境中对 DFS 和 OS 的有益作用仍存在差异，具有肿瘤特异性，且证据水平较低。
