Effects of epidural analgesia on cancer recurrence and long-term mortality in patients after non-small-cell lung cancer resection: a propensity score-matched study

Hsiang-Ling Wu; Ying-Hsuan Tai; Min-Ya Chan; Mei-Yung Tsou; Hsiu-Hsi Chen; Kuang-Yi Chang

doi:10.1136/bmjopen-2018-027618

Effects of epidural analgesia on cancer recurrence and long-term mortality in patients after non-small-cell lung cancer resection: a propensity score-matched study

BMJ Open. 2019 May 30;9(5):e027618. doi: 10.1136/bmjopen-2018-027618.

Authors

Hsiang-Ling Wu^{1

2}, Ying-Hsuan Tai^{1

2

3

4}, Min-Ya Chan⁵, Mei-Yung Tsou^{1

2}, Hsiu-Hsi Chen⁶, Kuang-Yi Chang^{1

2}

Affiliations

¹ Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.
² School of Medicine, National Yang-Ming University, Taipei, Taiwan.
³ Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁴ Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
⁵ Department of Technology Application and Human Resource Development, National Taiwan Normal University, Taipei, Taiwan.
⁶ Division of Biostatistics, Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.

Abstract

Objectives: Previous studies showed reductions in recurrence and mortality rate of several cancer types in patients receiving perioperative epidural analgesia. This study aimed to investigate the effects of thoracic epidural analgesia on oncological outcomes after resection for lung cancer.

Design: Retrospective study using propensity score matching methodology.

Setting: Single medical centre in Taiwan.

Participants: Patients with stages I-III non-small-cell lung cancer undergoing primary tumour resection between January 2005 and December 2015 and had either epidural analgesia, placed preoperatively and used intra- and postoperatively, or intravenous analgesia were evaluated through May 2017.

Primary and secondary outcome measures: Primary endpoint was postoperative recurrence-free survival and secondary endpoint was overall survival.

Results: The 3-year recurrence-free and overall survival rates were 69.8% (95% CI 67.4% to 72.2%) and 92.4% (95% CI 91% to 93.8%) in the epidural group and 67.4% (95% CI 62.3% to 72.5%) and 89.6% (95% CI 86.3% to 92.9%) in the non-epidural group, respectively. Multivariable Cox regression analysis before matching demonstrated no significant difference in recurrence or mortality between groups (adjusted HR: 0.93, 95% CI 0.76 to 1.14 for recurrence; 0.81, 95% CI 0.58 to 1.13 for mortality), similar to the results after matching (HR: 0.97, 95% CI 0.71 to 1.31; 0.94, 95% CI 0.57 to 1.54). Independent risk factors for both recurrence and mortality were male, higher pretreatment carcinoembryonic antigen level, advanced cancer stage, poor differentiation, lymphovascular invasion, microscopic necrosis and postoperative radiotherapy.

Conclusions: Thoracic epidural analgesia was not associated with better recurrence-free or overall survival in patients receiving surgical resection for stages I-III non-small-cell lung cancer.

Keywords: cancer; epidural analgesia; mortality; non-small-cell lung carcinoma; propensity score; recurrence.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Analgesia, Epidural* / adverse effects
Carcinoma, Non-Small-Cell Lung / complications
Carcinoma, Non-Small-Cell Lung / mortality
Carcinoma, Non-Small-Cell Lung / physiopathology
Carcinoma, Non-Small-Cell Lung / surgery*
Female
Humans
Lung Neoplasms / complications
Lung Neoplasms / mortality
Lung Neoplasms / physiopathology
Lung Neoplasms / surgery*
Male
Middle Aged
Neoplasm Recurrence, Local / etiology
Neoplasm Recurrence, Local / mortality
Neoplasm Recurrence, Local / pathology*
Neoplasm Staging
Pain, Postoperative / prevention & control*
Propensity Score*
Retrospective Studies
Survival Analysis
Taiwan / epidemiology
Thoracotomy / adverse effects*
Treatment Outcome