Association between intraoperative administration of dexamethasone and survival after curative resection for non-small cell lung cancer (NSCLC): A propensity score matching analysis

Background: Few studies have suggested the correlation between intraoperative dexamethasone and oncological outcomes in non-small cell lung cancer (NSCLC) patients with radical resection. The existing data are inconsistent and inadequate, and more evidence is needed. We therefore undertook a propensity-matched cohort study to investigate the correlation. Methods: 832 patients with stage I to IIIa NSCLC who went through a curative resection between January 2008 and December 2013 were enrolled in our study. Propensity-score matching analysis created a population of 206 patients in the non-DEX group and 103 patients in the DEX group. Cox regression analyses were applied to compare the disease-free survival (DFS) and overall survival (OS) between patients who did not and did receive dexamethasone in the propensity score-matched cohort, as well as in the certain patients with high-risk factors of postoperative nausea and vomiting. Results: After propensity score matching, intraoperative dexamethasone was not significantly associated with DFS (HR: 1.014, 95%CI: 0.786-1.309, P = 0.913) and OS (HR: 1.221, 95%CI: 0.905-1.647, P = 0.191). Multivariable cox regression analysis revealed that intraoperative dexamethasone was not still associated with DFS and OS after curative resection for NSCLC. In the subgroup analysis, intraoperative dexamethasone was significantly associated with improved DFS (HR: 0.20, 95%CI: 0.04-0.92, P = 0.038) in the group of anesthetic time less than 2 hours. In the subgroup of VATS, intraoperative dexamethasone was significantly associated with prolonged OS (HR: 0.53, 95%CI: 0.30-0.92, P = 0.023). Conclusion: There was no correlation between intraoperative administration of dexamethasone and survival in NSCLC patients after curative surgery. While patients given intraoperative dexamethasone had better disease-free survival compared with patients not given intraoperative dexamethasone in the subgroup of anesthetic time less than 2 hours. Intraoperative administration of dexamethasone may improve overall survival in the subgroup of VATS. Our results indicate that intraoperative administration of dexamethasone is probably favorable in the aforementioned populations.