接受肿瘤外科手术的患者术中使用地塞米松与术后死亡率的关联：一项多中心队列研究。

Association Between Intraoperative Dexamethasone and Postoperative Mortality in Patients Undergoing Oncologic Surgery: A Multicentric Cohort Study.

机构信息

Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

出版信息

Ann Surg. 2023 Jul 1;278(1):e105-e114. doi: 10.1097/SLA.0000000000005526. Epub 2022 Jul 18.

DOI:10.1097/SLA.0000000000005526

PMID:35837889

Abstract

OBJECTIVE

We examined the effects of dexamethasone on postoperative mortality, recurrence-free survival, and side effects in patients undergoing oncologic operations.

BACKGROUND

Dexamethasone prevents nausea and vomiting after anesthesia and may affect cancer proliferation.

METHODS

A total of 30,561 adult patients undergoing solid cancer resection between 2005 and 2020 were included. Multivariable logistic regression was applied to investigate the effect of dexamethasone on 1-year mortality and recurrence-free survival. Effect modification by the cancer's potential for immunogenicity, defined as a recommendation for checkpoint inhibitor therapy based on the National Comprehensive Cancer Network guidelines, was investigated through interaction term analysis. Key safety endpoints were dexamethasone-associated risk of hyperglycemia >180 mg/dL within 24 hours and surgical site infections within 30 days after surgery.

RESULTS

Dexamethasone was administered to 38.2% (11,666/30,561) of patients (6.5±2.3 mg). Overall, 3.2% (n=980/30,561) died and 15.4% (n=4718/30,561) experienced cancer recurrence within 1 year of the operation. Dexamethasone was associated with a -0.6% (95% confidence interval: -1.1, -0.2, P =0.007) 1-year mortality risk reduction [adjusted odds ratio (OR adj ): 0.79 (0.67, 0.94), P =0.009; hazard ratio=0.82 (0.69, 0.96), P =0.016] and higher odds of recurrence-free survival [OR adj : 1.28 (1.18, 1.39), P <0.001]. This effect was only present in patients with solid cancers who were defined as not to respond to checkpoint inhibitor therapy [OR adj : 0.70 (0.57, 0.87), P =0.001 vs OR adj : 1.13 (0.85, 1.50), P =0.40]. A high (>0.09 mg/kg) dose of dexamethasone increased the risk of postoperative hyperglycemia [OR adj : 1.55 (1.32, 1.82), P <0.001], but not for surgical site infections [OR adj : 0.84 (0.42, 1.71), P =0.63].

CONCLUSIONS

Dexamethasone is associated with decreased 1-year mortality and cancer recurrence in patients undergoing surgical resection of cancers that are not candidates for immune modulators. Dexamethasone increased the risk of postoperative hyperglycemia, however, no increase in surgical site infections was identified.

摘要

目的

研究地塞米松对接受肿瘤手术患者的术后死亡率、无复发生存率和副作用的影响。

背景

地塞米松可预防麻醉后恶心和呕吐，并可能影响癌症增殖。

方法

纳入 2005 年至 2020 年间接受实体癌切除术的 30561 名成年患者。采用多变量逻辑回归分析地塞米松对 1 年死亡率和无复发生存率的影响。通过交互项分析，研究地塞米松对癌症免疫原性潜在影响的效应修饰，这是根据国家综合癌症网络指南推荐使用检查点抑制剂治疗的标准。关键安全终点是术后 24 小时内血糖 >180mg/dL 和术后 30 天内手术部位感染的地塞米松相关风险。

结果

地塞米松在 30561 例患者中应用了 38.2%（11666/30561）（6.5±2.3mg）。总体而言，3.2%（n=980/30561）的患者在手术后 1 年内死亡，15.4%（n=4718/30561）发生癌症复发。地塞米松与 1 年死亡率风险降低 0.6%（95%置信区间：-1.1，-0.2，P=0.007）相关[调整后比值比（OR adj）：0.79（0.67，0.94），P=0.009；风险比=0.82（0.69，0.96），P=0.016]，且无复发生存率的优势更高[OR adj：1.28（1.18，1.39），P<0.001]。这种效果仅见于被定义为对检查点抑制剂治疗无反应的实体癌患者[OR adj：0.70（0.57，0.87），P=0.001 比 OR adj：1.13（0.85，1.50），P=0.40]。高（>0.09mg/kg）剂量的地塞米松增加了术后高血糖的风险[OR adj：1.55（1.32，1.82），P<0.001]，但不增加手术部位感染的风险[OR adj：0.84（0.42，1.71），P=0.63]。