Perioperative Glucocorticoids are Associated with Improved Recurrence-Free Survival After Pancreatic Cancer Surgery: A Retrospective Cohort Study with Propensity Score-Matching

Yun-Xiao Zhang,1,2 Dong-Liang Mu,1 Ke-Min Jin,3 Xue-Ying Li,4 Dong-Xin Wang1,5 1Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, People’s Republic of China; 2Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People’s Republic of China; 3Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Hepatic, Biliary & Pancreatic Surgery, Peking University Cancer Hospital & Institute, Beijing, People’s Republic of China; 4Department of Biostatistics, Peking University First Hospital, Beijing, People’s Republic of China; 5Outcomes Research Consortium, Cleveland, Ohio, United States of AmericaCorrespondence: Dong-Xin WangDepartment of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8 Xishiku Street, Beijing 100034, People’s Republic of ChinaTel +8610 83572784Fax +86 10 66551057Email dxwang65@bjmu.edu.cnPurpose: Perioperative anesthetic management may affect long-term outcome after cancer surgery. This study investigated the effect of perioperative glucocorticoids on long-term survival in patients after radical resection for pancreatic cancer.Methods: In this retrospective cohort study with propensity score-matching, patients who underwent radical resection for pancreatic cancer from January 2005 to December 2016 were recruited. Baseline and perioperative data including use of glucocorticoids for prevention of postoperative nausea and vomiting were collected. Patients were followed up by qualified personnel for cancer recurrence and survival. The primary outcome was the recurrence-free survival. Outcomes were compared before and after propensity matching. The association between perioperative glucocorticoid use and recurrence-free survival was analyzed with multivariable regression models.Results: A total of 215 patients were included in the study; of these, 112 received perioperative glucocorticoids and 103 did not. Patients were followed up for a median of 74.0 months (95% confidence interval [CI] 68.3– 79.7). After propensity score-matching, 64 patients remained in each group. The recurrence-free survivals were significantly longer in patients with glucocorticoids than in those without (full cohort: median 12.0 months [95% CI 6.0– 28.0] vs 6.9 months [4.2– 17.0], P< 0.001; matched cohort: median 12.0 months [95% CI 5.8– 26.3] vs 8.3 months [4.3– 18.2], P=0.015). After correction for confounding factors, perioperative glucocorticoids were significantly associated with prolonged recurrence-free survivals (full cohort: HR 0.66, 95% CI 0.48– 0.92, P=0.015; matched cohort: HR 0.54, 95% CI 0.35– 0.84, P=0.007).Conclusion: Perioperative use of low-dose glucocorticoids is associated with improved recurrence-free survival in patients following radical surgery for pancreatic cancer.Keywords: pancreatic cancer, surgery, perioperative management, glucocorticoids, survival