Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden.
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa050.
Non-steroidal anti-inflammatory drugs (NSAIDs) are known to suppress the inflammatory response after surgery and are often used for pain control. This study aimed to investigate NSAID use after radical surgical resection for rectal cancer and long-term oncological outcomes.
A cohort of patients who underwent anterior resection for rectal cancer between 2007 and 2013 in 15 hospitals in Sweden was investigated retrospectively. Data were obtained from the Swedish Colorectal Cancer Registry and medical records; follow-up was undertaken until July 2019. Patients who received NSAID treatment for at least 2 days after surgery were compared with controls who did not, and the primary outcome was recurrence-free survival. Cox regression modelling with confounder adjustment, propensity score matching, and an instrumental variables approach were used; missing data were handled by multiple imputation.
The cohort included 1341 patients, 362 (27.0 per cent) of whom received NSAIDs after operation. In analyses using conventional regression and propensity score matching, there was no significant association between postoperative NSAID use and recurrence-free survival (adjusted hazard ratio (HR) 1.02, 0.79 to 1.33). The instrumental variables approach, including individual hospital as the instrumental variable and clinicopathological variables as co-variables, suggested a potential improvement in the NSAID group (HR 0.61, 0.38 to 0.99).
conventional modelling did not demonstrate an association between postoperative NSAID use and recurrence-free survival in patients with rectal cancer, although an instrumental variables approach suggested a potential benefit.
非甾体抗炎药（NSAIDs）已知可抑制手术后的炎症反应，常用于控制疼痛。本研究旨在调查直肠癌根治性手术后 NSAID 的使用情况及其对长期肿瘤学结果的影响。
回顾性调查了瑞典 15 家医院在 2007 年至 2013 年间接受直肠前切除术的患者队列。数据来自瑞典结直肠癌登记处和病历；随访至 2019 年 7 月。接受 NSAID 治疗至少 2 天的患者与未接受 NSAID 治疗的对照组进行比较，主要结局为无复发生存。采用混杂因素调整的 Cox 回归模型、倾向评分匹配和工具变量方法进行分析；缺失数据采用多重插补处理。
该队列纳入了 1341 例患者，其中 362 例（27.0%）术后接受 NSAIDs 治疗。在常规回归和倾向评分匹配分析中，术后 NSAID 使用与无复发生存之间无显著关联（调整后的危险比（HR）1.02，0.79 至 1.33）。包含个体医院作为工具变量和临床病理变量作为协变量的工具变量方法提示 NSAID 组可能有生存获益（HR 0.61，0.38 至 0.99）。
常规模型未显示直肠癌患者术后 NSAID 使用与无复发生存之间存在关联，尽管工具变量方法提示可能有获益。
