Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2021 Jan 1;84(1):95-100. doi: 10.1097/JCMA.0000000000000446.
Although previous studies have shown connections between pain and worse cancer outcomes, few clinical studies have evaluated their direct association, and the current study aimed to investigate the potential association between acute pain trajectories and postoperative outcomes after liver cancer surgery.
This retrospective study was conducted in a single medical center and included patients who received liver cancer surgery between January 2010 and December 2016. Maximal pain intensity was recorded daily using a numerical rating scale during the first postoperative week. Group-based trajectory analysis was performed to classify the variations in pain scores over time. Cox and linear regression analyses were used to assess the effect of pain trajectories on recurrence-free survival, overall survival, and length of hospital stay (LOS) after surgery and to explore predictors of these outcomes.
A total of 804 patients with 5396 pain score observations were analyzed within the present study. Group-based trajectory analysis categorized the changes in postoperative pain into three groups: group 1 had constantly mild pain (76.6%), group 2 had moderate/severe pain dropping to mild (10.1%), and group 3 had mild pain rebounding to moderate (13.3%). Multivariable analysis demonstrated that on average, group 3 had a 7% increase in LOS compared with the group 1 (p = 0.02) and no significant difference in the LOS was noted between pain trajectory groups 2 and 1 (p = 0.93). Pain trajectories were not associated with recurrence-free survival or overall survival after liver cancer surgery.
Acute pain trajectories were associated with LOS but not cancer recurrence and survival after liver cancer surgery. Group-based trajectory analysis provided a promising approach for investigating the complex relationships between variations in postoperative pain over time and clinical outcomes.
尽管先前的研究表明疼痛与癌症预后恶化之间存在关联，但很少有临床研究评估它们之间的直接关联，本研究旨在探讨肝癌手术后急性疼痛轨迹与术后结局之间的潜在关联。
本回顾性研究在一家医疗中心进行，纳入 2010 年 1 月至 2016 年 12 月期间接受肝癌手术的患者。术后第一周每天使用数字评分量表记录最大疼痛强度。采用基于群组的轨迹分析方法对疼痛评分随时间的变化进行分类。Cox 和线性回归分析用于评估疼痛轨迹对肝癌手术后无复发生存、总生存和住院时间（LOS）的影响，并探讨这些结局的预测因素。
本研究共分析了 804 例患者的 5396 次疼痛评分观察值。基于群组的轨迹分析将术后疼痛变化分为三组：第 1 组为持续轻度疼痛（76.6%），第 2 组为中重度/严重疼痛降至轻度（10.1%），第 3 组为轻度疼痛反弹至中重度（13.3%）。多变量分析表明，平均而言，第 3 组的 LOS 比第 1 组增加了 7%（p = 0.02），而第 2 组和第 1 组之间的 LOS 无显著差异（p = 0.93）。疼痛轨迹与肝癌手术后无复发生存或总生存无关。
急性疼痛轨迹与肝癌手术后的 LOS 相关，但与癌症复发和生存无关。基于群组的轨迹分析为研究术后疼痛随时间变化与临床结局之间的复杂关系提供了一种有前途的方法。
