Luyckx Mathieu, Verougstraete Céline, Jouret Mathieu, Sawadogo Kiswendsida, Waterkeyn Marc, Grandjean Frédéric, Van Gossum Jean-Paul, Dubois Nathanael, Malvaux Vincent, Verreth Lucie, Grandjean Pascale, Jadoul Pascale, Maillard Charlotte, Gerday Amandine, Dieu Audrey, Forget Patrice, Baurain Jean-François, Squifflet Jean-Luc
UNGO (UCLouvain Network of Gynaecological Oncology), 1200 Brussel, Belgium.
Gynaecological Oncology Board, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium.
J Clin Med. 2024 Mar 7;13(6):1546. doi: 10.3390/jcm13061546.
Surgery is the cornerstone of ovarian cancer treatment. However, surgery and perioperative inflammation have been described as potentially pro-metastagenic. In various animal models and other human cancers, intraoperative administration of non-steroidal anti-inflammatory drugs (NSAIDs) appears to have a positive impact on patient outcomes.
In this unicentric retrospective study, we provide an exploratory analysis of the safety and potential benefit of intraoperative administration of ketorolac on the outcome of patients undergoing surgery for ovarian cancer. The study population included all patients who were given a diagnosis of ovarian, fallopian tube or peritoneal cancer by the multidisciplinary oncology committee (MOC) of the Cliniques universitaires Saint-Luc between 2015 and 2020.
We included 166 patients in our analyses, with a median follow-up of 21.8 months. Both progression-free survival and overall survival were superior in patients who received an intraoperative injection of ketorolac (34.4 months of progression-free survival in the ketorolac group versus 21.5 months in the non-ketorolac group ( = 0.002), and median overall survival was not reached in either group but there was significantly higher survival in the ketorolac group ( = 0.004)). We also performed subgroup analyses to minimise bias due to imbalance between groups on factors that could influence patient survival, and the group of patients receiving ketorolac systematically showed a better outcome. Uni- and multivariate analyses confirmed that administration of ketorolac intraoperatively was associated with better progression-free survival (HR = 0.47 on univariate analysis and 0.43 on multivariate analysis, = 0.003 and 0.023, respectively). In terms of complications, there were no differences between the two groups, either intraoperatively or postoperatively.
Our study has shown a favourable association between the use of ketorolac during surgery and the postoperative progression of ovarian cancer in a group of 166 patients, without any rise in intra- or postoperative complications. These encouraging results point to the need for a prospective study to confirm the benefit of intraoperative administration of ketorolac in ovarian cancer surgery.
手术是卵巢癌治疗的基石。然而，手术及围手术期炎症被认为可能具有促转移作用。在各种动物模型及其他人类癌症中，术中给予非甾体类抗炎药（NSAIDs）似乎对患者预后有积极影响。
在这项单中心回顾性研究中，我们对术中给予酮咯酸对卵巢癌手术患者预后的安全性及潜在益处进行了探索性分析。研究人群包括2015年至2020年间被圣吕克大学医院多学科肿瘤委员会（MOC）诊断为卵巢癌、输卵管癌或腹膜癌的所有患者。
我们纳入了166例患者进行分析，中位随访时间为21.8个月。接受术中注射酮咯酸的患者无进展生存期和总生存期均更优（酮咯酸组无进展生存期为34.4个月，非酮咯酸组为21.5个月（P = 0.002），两组中位总生存期均未达到，但酮咯酸组生存率显著更高（P = 0.004））。我们还进行了亚组分析，以尽量减少因可能影响患者生存的因素在组间不平衡导致的偏倚，接受酮咯酸治疗的患者组结果始终更好。单因素和多因素分析证实，术中给予酮咯酸与更好的无进展生存期相关（单因素分析中HR = 0.47，多因素分析中HR = 0.43，P分别为0.003和0.023）。在并发症方面，两组在术中及术后均无差异。
我们的研究表明，在一组166例患者中，手术期间使用酮咯酸与卵巢癌术后进展之间存在良好关联，且术中及术后并发症均未增加。这些令人鼓舞的结果表明需要进行前瞻性研究，以证实术中给予酮咯酸在卵巢癌手术中的益处。
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