Tsilimigras Diamantis I, Woldesenbet Selamawit, Chatzipanagiotou Odysseas P, Iyer Sidharth, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
Surgery. 2025 Mar;179:108794. doi: 10.1016/j.surg.2024.08.027. Epub 2024 Sep 20.
Lorazepam recently has been reported to alter the tumor microenvironment of pancreatic adenocarcinoma in a murine model. We sought to evaluate whether the use of lorazepam was associated with worse outcomes among patients with pancreatic adenocarcinoma.
Medicare beneficiaries diagnosed with stage I-IV pancreatic adenocarcinoma between 2013 and 2019 were identified from the Surveillance, Epidemiology and End Results-Medicare database. The association of lorazepam prescription relative to overall survival and recurrence-free survival was examined.
Among 2,810 patients with stage I-III and 10,181 patients with stage IV pancreatic adenocarcinoma, a total of 133 (4.7%) and 444 individuals (4.4%) had a lorazepam prescription before disease diagnosis, respectively. Although the overall lorazepam group had comparable 5-year overall survival (15.0% vs 14.2%, P = .20) and recurrence-free survival (12.7% vs 10.9%, P = .42) with the no-lorazepam group after pancreatic adenocarcinoma resection, individuals with long-term lorazepam prescription (>30 days) had worse 5-year overall survival (9.0% vs 21.0%, P = .02) and recurrence-free survival (6.4% vs 17.1%, P = .009) compared with short-term lorazepam users (≤30 days). Similarly, among patients with metastatic pancreatic adenocarcinoma, individuals with a long-term lorazepam prescription had worse 1-year overall survival (9.7% vs 15.9%, P = .02) compared with patients who had short-term lorazepam prescriptions. On multivariable analysis, long-term lorazepam prescription was independently associated with overall survival among patients with resectable (hazard ratio, 1.82; 95% confidence interval, 1.22-2.74) and metastatic pancreatic adenocarcinoma (hazard ratio, 1.24; 95% confidence interval, 1.02-1.51).
Long-term lorazepam prescription was associated with worse long-term outcomes among patients who underwent resection for pancreatic adenocarcinoma and patients with metastatic pancreatic adenocarcinoma. These data support the need for further large scale studies to confirm a potential harmful effect of lorazepam among patients with pancreatic adenocarcinoma.
最近有报道称，在小鼠模型中，劳拉西泮会改变胰腺腺癌的肿瘤微环境。我们试图评估使用劳拉西泮是否与胰腺腺癌患者的不良预后相关。
从监测、流行病学和最终结果-医疗保险数据库中识别出2013年至2019年间被诊断为I-IV期胰腺腺癌的医疗保险受益人。研究了劳拉西泮处方与总生存期和无复发生存期之间的关联。
在2810例I-III期胰腺腺癌患者和10181例IV期胰腺腺癌患者中，分别有133例（4.7%）和444例（4.4%）在疾病诊断前有劳拉西泮处方。尽管在胰腺腺癌切除术后，劳拉西泮组总体的5年总生存率（15.0%对14.2%，P = 0.20）和无复发生存率（12.7%对10.9%，P = 0.42）与未使用劳拉西泮组相当，但长期使用劳拉西泮（>30天）的患者与短期使用劳拉西泮（≤30天）的患者相比，5年总生存率更差（9.0%对21.0%，P = 0.02），无复发生存率也更差（6.4%对17.1%，P = 0.009）。同样，在转移性胰腺腺癌患者中，长期使用劳拉西泮的患者与短期使用劳拉西泮的患者相比，1年总生存率更差（9.7%对15.9%，P = 0.02）。在多变量分析中，长期使用劳拉西泮处方与可切除性胰腺腺癌患者（风险比，1.82；95%置信区间，1.22-2.74）和转移性胰腺腺癌患者的总生存期独立相关（风险比，1.24；95%置信区间，1.02-1.51）。
长期使用劳拉西泮处方与接受胰腺腺癌切除术的患者以及转移性胰腺腺癌患者的长期不良预后相关。这些数据支持需要进一步进行大规模研究，以证实劳拉西泮对胰腺腺癌患者的潜在有害影响。
