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Br J Anaesth. 2014 Jul;113 Suppl 1:i82-7. doi: 10.1093/bja/aet464. Epub 2014 Jan 23.

Intraoperative use of ketorolac or diclofenac is associated with improved disease-free survival and overall survival in conservative breast cancer surgery.

Author information

1
Department of Anesthesiology, forgetpatrice@yahoo.fr.
2
Department of Gynecology, and.
3
Department of Medical Oncology, Institut de Recherche Clinique et Expérimentale (pôle MIRO), Université catholique de Louvain, Brussels, Belgium.
4
de Duve Institute, Université catholique de Louvain, Brussels, Belgium.
5
Department of Anesthesiology.

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.

KEYWORDS:

conservative breast cancer surgery; neutrophil:lymphocyte ratio; non-steroidal anti-inflammatory drugs

PMID:
24464611
DOI:
10.1093/bja/aet464
[Indexed for MEDLINE]
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