Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2019 Apr;82(4):295-299. doi: 10.1097/JCMA.0000000000000054.
Few studies have investigated the association between epidural analgesia (EA) and oncologic outcomes in patients following hepatocellular carcinoma (HCC) resection.
This retrospective study was conducted at a single medical center using electronic medical records. Patients with nonmetastatic primary HCC undergoing tumor resection between January 2005 and December 2011 were classified into two groups based on their use of EA or intravenous analgesia. Multivariate Cox regression analyses were used to evaluate the associations between EA and recurrence-free (RFS) and overall (OS) survival. The patients were also propensity score-matched by demographic and important clinicopathologic variables.
A total of 744 patients (58.5% receiving EA) with a median follow-up time of 64.5 months and 277 matched pairs were included in the analyses before and after matching. No significant association between EA and cancer recurrence or overall mortality was found before matching (RFS: adjusted hazard ratio [HR] = 0.97, 95% CI: 0.80-1.17; OS: adjusted HR = 0.95, 95% CI: 0.71-1.26). After matching, the association between EA and cancer recurrence or overall mortality remained nonsignificant (RFS: HR = 0.89, 95% CI: 0.68-1.17; OS: HR = 1.20, 95% CI: 0.81-1.78).
This study did not support a definite association between EA and cancer recurrence or OS in patients with primary HCC after surgical resection.
很少有研究调查肝肿瘤切除术后患者硬膜外镇痛（EA）与肿瘤学结局之间的关系。
本回顾性研究在一家医疗中心使用电子病历进行。根据是否使用 EA 或静脉内镇痛，将 2005 年 1 月至 2011 年 12 月期间接受肿瘤切除术的非转移性原发性 HCC 患者分为两组。多变量 Cox 回归分析用于评估 EA 与无复发生存（RFS）和总生存（OS）之间的关联。根据人口统计学和重要临床病理变量，对患者进行倾向评分匹配。
共纳入 744 例患者（58.5%接受 EA），中位随访时间为 64.5 个月，匹配前和匹配后分别纳入 277 对匹配患者。匹配前，EA 与癌症复发或总死亡率之间无显著相关性（RFS：调整后的危险比 [HR] = 0.97，95%CI：0.80-1.17；OS：调整 HR = 0.95，95%CI：0.71-1.26）。匹配后，EA 与癌症复发或总死亡率之间的关联仍然不显著（RFS：HR = 0.89，95%CI：0.68-1.17；OS：HR = 1.20，95%CI：0.81-1.78）。
本研究不支持 EA 与原发性 HCC 手术后患者的癌症复发或 OS 之间存在明确关联。
