Niu Lingxia, Yao Chunlin, Wang Yu, Sun Yan, Xu Juan, Lin Yun, Yao Shanglong
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, People's Republic of China.
School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, Hubei, People's Republic of China.
Cancer Manag Res. 2020 Nov 6;12:11391-11402. doi: 10.2147/CMAR.S258016. eCollection 2020.
This study examined whether different neuromuscular-blocking agents (NMBAs) work differently on the short-term outcomes of gastric cancer patients in terms of laboratory test results and severity of postoperative illness, and whether the effect is dose-related.
Data of 1643 adult patients receiving gastric cancer surgery were analyzed by employing generalized linear models (GLMs), to explore the effects of different NMBAs on neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR) at postoperative day 1 (POD1), POD3, POD7, and return to intended oncologic therapy (RIOT), among others. We adjusted multiple covariants, including patient-, anesthesia-, and surgical complexity-related risk factors.
Without adjusting dosage of NMBAs, POD1NLR, POD1PLR ( < 0.05), POD3NLR, POD7NLR, POD3 lymphocytes, POD7LMR ( < 0.01) in gastric cancer patients administered with benzylisoquinoline NMBAs worsened, and the administration of aminosteroidal NMBAs was associated with less risk of transfer to ICU ( < 0.01); without adjusting the types of NMBAs, the highest dose of NMBAs postponed the RIOT ( < 0.05) and was negatively associated with POD3NLR, POD7NLR and POD7LMR ( < 0.01), and increased risk of postoperative transfer to ICU ( < 0.01). When patients given benzylisoquinolines were re-divided in terms of five equal quintiles, from low to high dose, RIOT was delayed and POD7LMR decreased significantly in the fourth and fifth quintile groups as compared to the first quintile group. A higher risk for postoperative transfer to ICU was found in the fifth quintile group as compared to the first quintile group.
Patients with gastric cancer given benzylisoquinoline NMBAs had more unfavorable short-term outcomes, such as more severe inflammation and increased risk of transfer to ICU than their counterparts administered aminosteroidal NMBAs, and the effect of benzylisoquinolines was dose-related. The effect of aminosteroids on short-term outcomes was not dose-related in the dosage range we used.
本研究探讨不同神经肌肉阻滞剂（NMBA）对胃癌患者短期预后的影响，包括实验室检查结果和术后病情严重程度，以及这种影响是否与剂量相关。
采用广义线性模型（GLM）分析1643例接受胃癌手术的成年患者的数据，以探讨不同NMBA对术后第1天（POD1）、POD3、POD7时的中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）以及恢复预期肿瘤治疗（RIOT）等的影响。我们调整了多个协变量，包括患者、麻醉和手术复杂性相关的危险因素。
在未调整NMBA剂量的情况下，接受苄基异喹啉类NMBA的胃癌患者POD1时的NLR、POD1时的PLR（<0.05）、POD3时的NLR、POD7时的NLR、POD3时的淋巴细胞、POD7时的LMR（<0.01）恶化，而使用氨基甾体类NMBA与转入重症监护病房（ICU）的风险较低相关（<0.01）；在未调整NMBA类型的情况下，NMBA的最高剂量延迟了RIOT（<0.05），并与POD3时的NLR、POD7时的NLR和POD7时的LMR呈负相关（<0.01），且增加了术后转入ICU的风险（<0.01）。当接受苄基异喹啉类药物的患者按剂量由低到高分为五个相等的五分位数重新分组时，与第一五分位数组相比，第四和第五五分位数组的RIOT延迟，POD7时的LMR显著降低。与第一五分位数组相比，第五五分位数组术后转入ICU的风险更高。
与接受氨基甾体类NMBA的患者相比，接受苄基异喹啉类NMBA的胃癌患者短期预后更差，如炎症更严重、转入ICU的风险增加，且苄基异喹啉类药物的作用与剂量相关。在我们使用的剂量范围内，氨基甾体类药物对短期预后的影响与剂量无关。
