Long-Term Outcomes after Use of Perioperative Glucocorticoids in Patients Undergoing Cancer Surgery: A Systematic Review and Meta-Analysis
Open Access
- 27 December 2019
- Vol. 12 (1), 76
- https://doi.org/10.3390/cancers12010076
Abstract
The surgical stress response can accelerate clinical metastasis formation. Perioperative glucocorticoids might modulate this response and the metastatic process. We aimed to describe associations between perioperative glucocorticoids and long-term outcomes after cancer surgery. We searched four databases for eligible trials and performed meta-analyses on frequency and time-to-event data. We included sixteen studies that evaluated eight different cancer types. No association was found between perioperative glucocorticoids and recurrence in either the frequency meta-analysis, risk ratio (RR) 1.04, 95% confidence interval (CI) (0.87–1.25), or in the time-to-event meta-analysis, hazard ratio (HR) 1.18, 95% CI (0.78–1.79). Increased 1-year overall survival, RR 0.70, 95% (0.51–0.97), and disease-free survival, RR 0.77, 95% CI (0.60–0.97), was found for the glucocorticoid group, but five years after surgery, overall survival was reduced for the glucocorticoid group, RR 1.64, 95% CI (1.00–2.71). An exploratory subgroup analysis revealed decreased overall survival, HR 1.78, 95% CI (1.57–2.03), for patients undergoing colorectal cancer surgery while receiving glucocorticoids. Perioperative glucocorticoids were not associated with recurrence after cancer surgery. We found neither beneficial or deleterious associations between glucocorticoids and overall survival or disease-free survival. The available evidence remains heterogenous; low in quality and amount; and cancer-specific at present.This publication has 42 references indexed in Scilit:
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trialsBMJ, 2011
- Preoperative Glucocorticoid Use in Major Abdominal SurgeryAnnals of Surgery, 2011
- Randomized clinical trial of the effect of glucocorticoids on peritoneal inflammation and postoperative recovery after colectomyBritish Journal of Surgery, 2009
- A Re-Evaluation of Random-Effects Meta-AnalysisJournal of the Royal Statistical Society Series A: Statistics in Society, 2008
- Practical methods for incorporating summary time-to-event data into meta-analysisTrials, 2007
- Perioperative blood transfusions and recurrence of colorectal cancerEmergencias, 2006
- Development of less invasive surgical procedures for thoracic esophageal cancerDiseases of the Esophagus, 2004
- Effect of steroid therapy on postoperative course and survival of patients with thoracic esophageal carcinomaEsophagus, 2004
- Risks and Benefits of Preoperative High Dose Methylprednisolone in Surgical PatientsDrug Safety, 2000