H C Yu1, Y X Luo2, H Peng3, L Kang3, M J Huang3, J P Wang4. 1. Department of Colorectal and Anal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China. Electronic address: yuhuichuan819@gmail.com. 2. Department of Colorectal and Anal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China; Gastrointestinal Institute, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China. Electronic address: luoyx25@mail.sysu.edu.cn. 3. Department of Colorectal and Anal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China. 4. Department of Colorectal and Anal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China; Gastrointestinal Institute, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China. Electronic address: wjp@mail.sysu.edu.cn.
Abstract
BACKGROUND: Perioperative administration of dexamethasone may augment recurrence and mortality after tumor resection possibly by immunosuppression, which, unfortunately, has never been noted. We therefore carried out a retrospective study in rectal cancer to validate the hypothesis. METHODS: Five hundreds and fifteen patients with stage I to III rectal cancers who underwent a curative resection from June 2007 and June 2011 were enrolled in the current study. Patients who had been given intravenous (IV) dexamethasone (4-10 mg) postoperatively and/or intraoperatively were assigned to dexamethasone group. The outcome of dexamethasone group and non-dexamethasone group were compared. The primary outcome was disease-free survival (DFS) and overall survival (OS). RESULTS: dexamethasone group had significant lower three-year DFS (62.3% vs 71.8%, P = 0.026) and OS (74.1% vs 82.9%, P = 0.031) rate in comparison to non-dexamethasone group, the hazard ratios (HRs) of which were 1.59 (95% CI 1.05-2.39, P = 0.028) and 1.77 (95% CI 1.05-3.01, P = 0.034), respectively. Multivariate analysis revealed that administration of systemic dexamethasone were independently associated with DFS [adjusted HR 1.60 (95% CI 1.03-2.49, p = 0.039)], but for OS, dexamethasone didn't remain significant in this model. In the analyses of a subgroup of 428 patients (55/428 in dexamethasone group) without perioperative blood transfusion, dexamethasone had independently impact on both DFS and OS. CONCLUSION: Patients not given dexamethasone had better three-year survival outcomes compared with patients given dexamethasone perioperatively. Our results indicate that rectal cancer patients treated with curative surgery may get survival benefit from avoiding low-dose perioperative dexamethasone.
BACKGROUND: Perioperative administration of dexamethasone may augment recurrence and mortality after tumor resection possibly by immunosuppression, which, unfortunately, has never been noted. We therefore carried out a retrospective study in rectal cancer to validate the hypothesis. METHODS: Five hundreds and fifteen patients with stage I to III rectal cancers who underwent a curative resection from June 2007 and June 2011 were enrolled in the current study. Patients who had been given intravenous (IV) dexamethasone (4-10 mg) postoperatively and/or intraoperatively were assigned to dexamethasone group. The outcome of dexamethasone group and non-dexamethasone group were compared. The primary outcome was disease-free survival (DFS) and overall survival (OS). RESULTS:dexamethasone group had significant lower three-year DFS (62.3% vs 71.8%, P = 0.026) and OS (74.1% vs 82.9%, P = 0.031) rate in comparison to non-dexamethasone group, the hazard ratios (HRs) of which were 1.59 (95% CI 1.05-2.39, P = 0.028) and 1.77 (95% CI 1.05-3.01, P = 0.034), respectively. Multivariate analysis revealed that administration of systemic dexamethasone were independently associated with DFS [adjusted HR 1.60 (95% CI 1.03-2.49, p = 0.039)], but for OS, dexamethasone didn't remain significant in this model. In the analyses of a subgroup of 428 patients (55/428 in dexamethasone group) without perioperative blood transfusion, dexamethasone had independently impact on both DFS and OS. CONCLUSION:Patients not given dexamethasone had better three-year survival outcomes compared with patients given dexamethasone perioperatively. Our results indicate that rectal cancerpatients treated with curative surgery may get survival benefit from avoiding low-dose perioperative dexamethasone.
Authors: Peter Kienbaum; Maximilian S Schaefer; Stephanie Weibel; Tobias Schlesinger; Patrick Meybohm; Leopold H Eberhart; Peter Kranke Journal: Anaesthesist Date: 2021-10-01 Impact factor: 1.041
Authors: Silvia Zappavigna; Alessia Maria Cossu; Anna Grimaldi; Marco Bocchetti; Giuseppe Andrea Ferraro; Giovanni Francesco Nicoletti; Rosanna Filosa; Michele Caraglia Journal: Int J Mol Sci Date: 2020-04-09 Impact factor: 5.923