硬膜外鎮痛對直腸癌切除術后復發或死亡率的影響

貴州醫科大學 高鴻教授課題組

翻譯：任文鑫 編輯：佟睿 審校：曹瑩

 

總結

硬膜外鎮痛與直腸癌預后的關系尚未完全闡明。我們的目的是研究硬膜外鎮痛對直腸腫瘤切除術后復發和死亡率的影響。在這項單中心隊列研究中，我們連續招募了2005-2014年間接受腫瘤切除術的I-III期直腸癌患者。患者接受硬膜外鎮痛或靜脈阿片類藥物鎮痛以控制術后疼痛。主要觀察指標是首次癌癥復發。次要觀察指標是全因死亡率和癌癥特異性死亡率。我們收集了1282例進行逆概率治療加權分析的患者，其中237例患者(18.5%)使用硬膜外麻醉。隨訪時間中位數為46.1個月。加權COX回歸分析顯示硬膜外鎮痛與無復發生存率的關系無顯著性意義(調整風險比[HR]0.941，95%CI 0.791~1.119，p=0.491)。同樣，硬膜外鎮痛與總生存率(HR 0.997，95%CI 0.775-1.283，p=0.984)或腫瘤特異性生存率(HR 1.113，95%CI 0.826-1.501，p=0.482)之間的關系也不顯著。對于敏感性測試，五分位分層和逐步正向模型選擇分析顯示了類似的結果。在接受腫瘤切除術的直腸癌患者中，我們沒有發現硬膜外鎮痛與復發風險、全因死亡率或腫瘤特異性死亡率之間的顯著關聯。

Epidural analgesia does not impact recurrence or mortality in patients after rectal cancer resection

 

Summary

The relationship between epidural analgesia and rectal cancer outcome is not fully clarifed. We aimed to investigate the putative efect of epidural analgesia on the risks of recurrence and mortality after rectal tumour resection. In this monocentric cohort study, we consecutively enrolled patients with stage I–III rectal cancer who underwent tumour resection from 2005 to 2014. Patients received epidural analgesia or intravenous opioid-based analgesia for postoperative pain control. Primary endpoint was frst cancer recurrence. Secondary endpoints were all-cause mortality and cancer-specifc

mortality. We collected 1282 patients in the inverse probability of treatment weighting analyses, and 237 (18.5%) used epidurals. Follow-up interval was median 46.1 months. Weighted Cox regression analysis showed the association between epidural analgesia and recurrence-free survival was nonsignifcant (adjusted hazard ratio [HR] 0.941, 95% CI 0.791–1.119, p = 0.491). Similarly, the association between epidural analgesia and overall survival (HR 0.997, 95% CI 0.775–1.283, p = 0.984) or cancerspecifc survival (HR 1.113, 95% CI 0.826–1.501, p = 0.482) was non-signifcant either. For sensitivity tests, quintile stratifcation and stepwise forward model selection analyses showed similar results. We did not fnd a signifcant association between epidural analgesia and risk of recurrence, all-cause mortality, or cancer-specifc mortality in patients with rectal cancer undergoing tumour resection.