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  • Effects of epidural analgesia on cancer recurrence and long-term mortality in patients after non-small-cell lung cancer resection: a propensity score-matched study

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Anaesthesia
Research
Effects of epidural analgesia on cancer recurrence and long-term mortality in patients after non-small-cell lung cancer resection: a propensity score-matched study
  1. Hsiang-Ling Wu1,2,
  2. Ying-Hsuan Tai1,2,3,4,
  3. Min-Ya Chan5,
  4. Mei-Yung Tsou1,2,
  5. Hsiu-Hsi Chen6,
  6. Kuang-Yi Chang1,2
  1. 1 Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
  2. 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan
  3. 3 Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  4. 4 Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
  5. 5 Department of Technology Application and Human Resource Development, National Taiwan Normal University, Taipei, Taiwan
  6. 6 Division of Biostatistics, Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
  1. Correspondence to Dr Kuang-Yi Chang; kychang{at}vghtpe.gov.tw

Abstract

Objectives Previous studies showed reductions in recurrence and mortality rate of several cancer types in patients receiving perioperative epidural analgesia. This study aimed to investigate the effects of thoracic epidural analgesia on oncological outcomes after resection for lung cancer.

Design Retrospective study using propensity score matching methodology.

Setting Single medical centre in Taiwan.

Participants Patients with stages I–III non-small-cell lung cancer undergoing primary tumour resection between January 2005 and December 2015 and had either epidural analgesia, placed preoperatively and used intra- and postoperatively, or intravenous analgesia were evaluated through May 2017.

Primary and secondary outcome measures Primary endpoint was postoperative recurrence-free survival and secondary endpoint was overall survival.

Results The 3-year recurrence-free and overall survival rates were 69.8% (95% CI 67.4% to 72.2%) and 92.4% (95% CI 91% to 93.8%) in the epidural group and 67.4% (95% CI 62.3% to 72.5%) and 89.6% (95% CI 86.3% to 92.9%) in the non-epidural group, respectively. Multivariable Cox regression analysis before matching demonstrated no significant difference in recurrence or mortality between groups (adjusted HR: 0.93, 95% CI 0.76 to 1.14 for recurrence; 0.81, 95% CI 0.58 to 1.13 for mortality), similar to the results after matching (HR: 0.97, 95% CI 0.71 to 1.31; 0.94, 95% CI 0.57 to 1.54). Independent risk factors for both recurrence and mortality were male, higher pretreatment carcinoembryonic antigen level, advanced cancer stage, poor differentiation, lymphovascular invasion, microscopic necrosis and postoperative radiotherapy.

Conclusions Thoracic epidural analgesia was not associated with better recurrence-free or overall survival in patients receiving surgical resection for stages I–III non-small-cell lung cancer.

  • epidural analgesia
  • cancer
  • recurrence
  • mortality
  • non-small-cell lung carcinoma
  • propensity score

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-027618

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    Footnotes

    • Contributors The author contributions were as follows: H.L.W. and Y.H.T. contributed to data acquisition and manuscript drafting. M.Y.C. helped in data verification. M.Y.T. helped revise the manuscript. H.H.C. contributed to study design and statistical analysis. K.Y.C. contributed to statistical review, manuscript revision and final approval of the version to be published. All authors read and approved the final manuscript.

    • Funding This work was supported by the grants from Taipei Veterans General Hospital, Taipei, Taiwan (V105C-050) and Ministry of Science and Technology, Taipei, Taiwan (MOST 104-2314-B-075-015).

    • Competing interests None declared.

    • Ethics approval The study was approved by the Institutional Review Board of Taipei Veterans General Hospital, Taipei, Taiwan (IRB-TPEVGH No. 2015-11-010CC).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.

    • Patient consent for publication Not required.