Sun Mingyang, Xie Peilin, Chen Wan-Ming, Wu Szu-Yuan, Zhang Jiaqiang
Department of Anesthesiology and Perioperative Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China
Institute of Electrophysiology, Henan Academy of Innovations in Medical Science, Zhengzhou, Henan, China.
BMJ Health Care Inform. 2025 Jul 7;32(1):e101344. doi: 10.1136/bmjhci-2024-101344.
To investigate the association between perioperative dexmedetomidine (DEX) use and oncological outcomes-including locoregional recurrence (LRR) and distant metastasis (DM)-in patients undergoing curative surgery for oral cavity squamous cell carcinoma (OCSCC).
This retrospective cohort study used data from the Taiwan Cancer Registry Database and included patients with stage I-IVB OCSCC who underwent curative surgery between 2007 and 2019. Patients were categorised by DEX exposure status and matched 1:1 using propensity score matching (PSM) based on key clinical and demographic variables. Cox proportional hazards models and competing risk analyses were used to estimate the association between DEX use and oncological outcomes.
After PSM, 8024 patients (4012 per group) were included. Multivariable Cox regression showed that perioperative DEX use was significantly associated with increased risks of LRR (adjusted HR (aHR) 1.67; 95% CI 1.55 to 1.80; p<0.001) and DM (aHR 1.30; 95% CI 1.19 to 1.42; p<0.001).
These findings suggest a potential oncological risk associated with perioperative DEX administration. Possible mechanisms include immune modulation and enhanced metastatic potential, as reported in preclinical studies. Further investigation is needed to clarify causal pathways and identify patient subgroups most affected.
Perioperative DEX use is independently associated with increased risks of LRR and DM in OCSCC patients. These results underscore the importance of cautious perioperative management and the need for prospective validation in randomised clinical trials.
探讨口腔鳞状细胞癌（OCSCC）根治性手术患者围手术期使用右美托咪定（DEX）与肿瘤学结局（包括局部区域复发（LRR）和远处转移（DM））之间的关联。
这项回顾性队列研究使用了台湾癌症登记数据库的数据，纳入了2007年至2019年间接受根治性手术的I-IVB期OCSCC患者。根据DEX暴露状态对患者进行分类，并基于关键临床和人口统计学变量使用倾向评分匹配（PSM）进行1:1匹配。使用Cox比例风险模型和竞争风险分析来估计DEX使用与肿瘤学结局之间的关联。
PSM后，纳入了8024例患者（每组4012例）。多变量Cox回归显示，围手术期使用DEX与LRR风险增加（调整后风险比（aHR）1.67；95%置信区间1.55至1.80；p<0.001）和DM风险增加（aHR 1.30；95%置信区间1.19至1.42；p<0.001）显著相关。
这些发现表明围手术期使用DEX存在潜在的肿瘤学风险。如临床前研究所报道，可能的机制包括免疫调节和转移潜能增强。需要进一步研究以阐明因果途径并确定受影响最大的患者亚组。
OCSCC患者围手术期使用DEX与LRR和DM风险增加独立相关。这些结果强调了谨慎的围手术期管理的重要性以及在随机临床试验中进行前瞻性验证的必要性。
