1. Intraoperative use of ketorolac or diclofenac is associated with improved disease-free survival and overall survival in conservative breast cancer surgery.
- Author
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Forget P, Bentin C, Machiels JP, Berliere M, Coulie PG, and De Kock M
- Subjects
- Adult, Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal administration & dosage, Breast Neoplasms blood, Diclofenac administration & dosage, Disease-Free Survival, Drug Administration Schedule, Drug Evaluation methods, Female, Humans, Kaplan-Meier Estimate, Ketorolac administration & dosage, Lymphocyte Count, Middle Aged, Neutrophils pathology, Prognosis, Retrospective Studies, Treatment Outcome, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Breast Neoplasms surgery, Diclofenac therapeutic use, Intraoperative Care methods, Ketorolac therapeutic use, Mastectomy, Segmental
- Abstract
Background: An association between the use of non-steroidal anti-inflammatory drugs (NSAIDs) and better outcome after mastectomy and lung surgery for cancer has been recently suggested. In a retrospective analysis, we investigated the association between intraoperative NSAIDs use in conservative breast cancer surgery and breast cancer disease-free survival (DFS). Similarly, we also evaluated the association between breast cancer DFS and preoperative neutrophil:lymphocyte ratio (NLR)., Methods: A retrospective analysis of a single-centre cohort was performed in breast cancer patients (n=720) with uni- and multivariate analyses, using a Cox regression model., Results: In conservative breast cancer surgery, the intraoperative use of NSAIDs (ketorolac or diclofenac) was associated with an improved DFS {hazard ratio (HR)=0.57 [95% confidence interval (CI): 0.37-0.89], P=0.01} and an improved overall survival (OS) [HR=0.35 (95% CI: 0.17-0.70), P=0.03]. In these patients, an NLR >3.3 (identified by a receiver-operating characteristic curve) was associated with a shorter DFS [HR=1.99 (95% CI: 1.16-3.41), P=0.01] and OS [HR=2.35 (95% CI: 1.02-5.43), P=0.046]., Conclusions: Intraoperative NSAIDs and higher preoperative NLR are associated with improved outcome in conservative breast cancer surgery. Prospective, randomized trials to evaluate if these associations are causal are warranted., (© The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2014
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