Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China.
Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong, China.
Int J Colorectal Dis. 2020 Apr;35(4):695-704. doi: 10.1007/s00384-020-03528-8. Epub 2020 Feb 10.
Nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to block tumor-associated inflammation in rectal cancer. However, the perioperative use of NSAIDs remains controversial. This study was designed to investigate whether the perioperative use of NSAIDs influences outcomes and to provide a predictive marker to identify patients who would benefit from NSAIDs.
We enrolled 515 patients with stage I to III rectal cancer in this retrospective study. Patients were classified into the NSAID and non-NSAID groups according to their perioperative use of NSAIDs. The whole cohort was stratified by platelet-to-lymphocyte ratio (PLR). The primary endpoints were disease-free survival (DFS) and overall survival (OS).
The NSAID group had a 12.6% lower risk of recurrence than the non-NSAID group (P = 0.015), while the association with survival was nonsignificant. In the high-PLR subset, the NSAID group had a 17.3% lower risk of recurrence (P = 0.003) and a better DFS (P = 0.033) outcome than the non-NSAID group. Multivariate analysis confirmed this independent significant association with DFS (P = 0.023). In the low-PLR subset, the association of NSAID use with survival was nonsignificant.
Perioperative use of NSAIDs was associated with improved survival outcomes in rectal cancer patients with high PLR.
非甾体抗炎药（NSAIDs）已被证明可阻断直肠癌相关的炎症。然而，NSAIDs 的围手术期使用仍存在争议。本研究旨在探讨 NSAIDs 的围手术期使用是否会影响结局，并提供预测标志物以识别可能从 NSAIDs 中获益的患者。
我们对 515 例 I 期至 III 期直肠癌患者进行了回顾性研究。根据 NSAIDs 的围手术期使用情况，患者分为 NSAIDs 组和非 NSAIDs 组。整个队列根据血小板与淋巴细胞比值（PLR）进行分层。主要终点是无病生存期（DFS）和总生存期（OS）。
与非 NSAIDs 组相比，NSAIDs 组的复发风险降低了 12.6%（P=0.015），但与生存的相关性无统计学意义。在高 PLR 亚组中，NSAIDs 组的复发风险降低了 17.3%（P=0.003），DFS 更好（P=0.033）。多变量分析证实了这与 DFS 的独立显著相关性（P=0.023）。在低 PLR 亚组中，NSAIDs 使用与生存的相关性无统计学意义。
对于 PLR 较高的直肠癌患者，围手术期使用 NSAIDs 与改善生存结局相关。
