The effect of epidural analgesia on cancer progression in patients with stage IV colorectal cancer after primary tumor resection: A retrospective cohort study.
Retrospective clinical studies showed perioperative epidural analgesia (EA) was associated with better postoperative oncologic outcomes in patients with specific types of non-metastatic cancers. This study aimed to investigate the effects of EA on cancer prognosis after surgical intervention for sta...
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Public Library of Science (PLoS)
2018-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0200893&type=printable |
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| author | Ying-Hsuan Tai Wen-Kuei Chang Hsiang-Ling Wu Min-Ya Chan Hsiu-Hsi Chen Kuang-Yi Chang |
| author_facet | Ying-Hsuan Tai Wen-Kuei Chang Hsiang-Ling Wu Min-Ya Chan Hsiu-Hsi Chen Kuang-Yi Chang |
| author_sort | Ying-Hsuan Tai |
| collection | DOAJ |
| description | Retrospective clinical studies showed perioperative epidural analgesia (EA) was associated with better postoperative oncologic outcomes in patients with specific types of non-metastatic cancers. This study aimed to investigate the effects of EA on cancer prognosis after surgical intervention for stage IV colorectal cancer. In this retrospective study, patients with stage IV colorectal cancer undergoing primary tumor resection and metastasectomy between January 2005 and December 2014 were classified into two groups based on their use of perioperative EA or not and evaluated through August 2016. Primary and secondary endpoints were postoperative progression-free survival (PFS) and overall survival (OS), respectively. A total of 999 patients were included and 165 (16.5%) of them received EA. The median follow-up interval was 17.5 months and no significant difference in PFS or OS was noted between the EA and non-EA groups in the univariate analysis. Multivariable Cox proportional hazards model identified four independent risk factors both for disease progression and mortality, including American Society of Anesthesiologists (ASA) physical status ≥ 3, higher pretreatment carcinoembryonic antigen (CEA), multiple distant metastases, and pathologic lymphovascular invasion. After adjustment for the selected risk factors, the effects of EA on PFS and OS remained non-significant (hazard ratio: 1.06, 95% CI: 0.87 to 1.29, for PFS and 0.90, 95% CI: 0.68 to 1.20 for OS). Similar findings were demonstrated by propensity score analysis. Our results did not support the association between perioperative epidural analgesia and better progression-free or overall survival in patients following stage IV colorectal cancer surgery. |
| format | Article |
| id | doaj-art-1632cbda28604067baec2d10536502d9 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-1632cbda28604067baec2d10536502d92025-08-20T02:45:53ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01137e020089310.1371/journal.pone.0200893The effect of epidural analgesia on cancer progression in patients with stage IV colorectal cancer after primary tumor resection: A retrospective cohort study.Ying-Hsuan TaiWen-Kuei ChangHsiang-Ling WuMin-Ya ChanHsiu-Hsi ChenKuang-Yi ChangRetrospective clinical studies showed perioperative epidural analgesia (EA) was associated with better postoperative oncologic outcomes in patients with specific types of non-metastatic cancers. This study aimed to investigate the effects of EA on cancer prognosis after surgical intervention for stage IV colorectal cancer. In this retrospective study, patients with stage IV colorectal cancer undergoing primary tumor resection and metastasectomy between January 2005 and December 2014 were classified into two groups based on their use of perioperative EA or not and evaluated through August 2016. Primary and secondary endpoints were postoperative progression-free survival (PFS) and overall survival (OS), respectively. A total of 999 patients were included and 165 (16.5%) of them received EA. The median follow-up interval was 17.5 months and no significant difference in PFS or OS was noted between the EA and non-EA groups in the univariate analysis. Multivariable Cox proportional hazards model identified four independent risk factors both for disease progression and mortality, including American Society of Anesthesiologists (ASA) physical status ≥ 3, higher pretreatment carcinoembryonic antigen (CEA), multiple distant metastases, and pathologic lymphovascular invasion. After adjustment for the selected risk factors, the effects of EA on PFS and OS remained non-significant (hazard ratio: 1.06, 95% CI: 0.87 to 1.29, for PFS and 0.90, 95% CI: 0.68 to 1.20 for OS). Similar findings were demonstrated by propensity score analysis. Our results did not support the association between perioperative epidural analgesia and better progression-free or overall survival in patients following stage IV colorectal cancer surgery.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0200893&type=printable |
| spellingShingle | Ying-Hsuan Tai Wen-Kuei Chang Hsiang-Ling Wu Min-Ya Chan Hsiu-Hsi Chen Kuang-Yi Chang The effect of epidural analgesia on cancer progression in patients with stage IV colorectal cancer after primary tumor resection: A retrospective cohort study. PLoS ONE |
| title | The effect of epidural analgesia on cancer progression in patients with stage IV colorectal cancer after primary tumor resection: A retrospective cohort study. |
| title_full | The effect of epidural analgesia on cancer progression in patients with stage IV colorectal cancer after primary tumor resection: A retrospective cohort study. |
| title_fullStr | The effect of epidural analgesia on cancer progression in patients with stage IV colorectal cancer after primary tumor resection: A retrospective cohort study. |
| title_full_unstemmed | The effect of epidural analgesia on cancer progression in patients with stage IV colorectal cancer after primary tumor resection: A retrospective cohort study. |
| title_short | The effect of epidural analgesia on cancer progression in patients with stage IV colorectal cancer after primary tumor resection: A retrospective cohort study. |
| title_sort | effect of epidural analgesia on cancer progression in patients with stage iv colorectal cancer after primary tumor resection a retrospective cohort study |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0200893&type=printable |
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