Wu Hsiang-Ling, Tai Ying-Hsuan, Mandell Mercedes Susan, Tsou Mei-Yung, Yang Shung-Haur, Chen Tony Hsiu-Hsi, Chang Kuang-Yi
Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
BMJ Open. 2020 Oct 22;10(10):e036577. doi: 10.1136/bmjopen-2019-036577.
Whether epidural analgesia affects cancer outcomes remains controversial. Most previous investigations ignored the confounding potential of important pathological factors on cancer outcomes. This study aimed to assess the association between epidural analgesia and cancer recurrence or death after resections for colon cancer.
Retrospective cohort study.
A single-medical centre in Taiwan.
Patients with stage I through III colon cancer undergoing bowel resection and receiving either epidural analgesia or intravenous opioid analgesia from 2005 to 2014.
Primary outcome was postoperative recurrence-free survival and secondary outcome was overall survival.
A total of 2748 and 1218 patients were analysed before and after propensity score matching. Cox regression analyses did not demonstrate any association between epidural analgesia and recurrence or death after matching (HR 0.89, 95% CI 0.65 to 1.21 for recurrence; 0.72, 95% CI 0.48 to 1.09 for death). Independent prognostic factors for cancer recurrence and death were higher level of preoperative carcinoembryonic antigen, perioperative blood transfusion, advanced cancer stage and pathological lymphovascular invasion.
No definite association was found between epidural analgesia and risk of recurrence or death in patients undergoing colon cancer resection.
硬膜外镇痛是否会影响癌症预后仍存在争议。以往大多数研究忽略了重要病理因素对癌症预后的潜在混杂影响。本研究旨在评估硬膜外镇痛与结肠癌切除术后癌症复发或死亡之间的关联。
回顾性队列研究。
台湾的一个单一医疗中心。
2005年至2014年间接受肠道切除并接受硬膜外镇痛或静脉注射阿片类镇痛的Ⅰ至Ⅲ期结肠癌患者。
主要结局是术后无复发生存期，次要结局是总生存期。
倾向评分匹配前后分别分析了2748例和1218例患者。Cox回归分析未显示硬膜外镇痛与匹配后的复发或死亡之间存在任何关联（复发的HR为0.89，95%CI为0.65至1.21；死亡的HR为0.72，95%CI为0.48至1.09）。癌症复发和死亡的独立预后因素包括术前癌胚抗原水平较高、围手术期输血、癌症晚期和病理淋巴管浸润。
在接受结肠癌切除术的患者中，未发现硬膜外镇痛与复发或死亡风险之间存在明确关联。
