title: Is dexamethasone associated with recurrence of ovarian cancer?
abstract: BACKGROUND
  Basic science studies suggest that perioperative immune impairment may augment the risk of cancer recurrence after otherwise potentially curative surgery. Despite its immunosuppressant properties, dexamethasone is commonly given to oncologic patients in an effort to reduce postoperative nausea and vomiting. We therefore tested the hypothesis that perioperative dexamethasone administration increases the risk of ovarian cancer recurrence.
  
  
  METHODS
  Women who had primary ovarian cytoreductive surgery between January 1997 and October 2007 were identified using a database maintained by the division of Gynecologic Oncology at Northwestern University. Tumor recurrence in women given perioperative systemic dexamethasone (4-10 mg) was compared with those who did not receive dexamethasone. The primary outcome was the propensity-matched time to cancer recurrence. Recurrence was defined by a carcinoantigen 125 >21 U/mL or computerized tomography evidence of the disease followed by tissue confirmation. Median difference and 95% confidence interval between the propensity-matched groups were calculated using a 10,000 sample bootstrap.
  
  
  RESULTS
  Among 260 women having primary cytoreductive surgery for ovarian cancer that met our inclusion criteria, 102 subjects were given perioperative systemic dexamethasone. Cancer recurrence was observed in 178 subjects, and the overall unadjusted median (IQR) time to recurrence was 18 (7-50) months. Eighty-seven cases and 87 controls were propensity matched to adjust for confounding covariates. After propensity matching the groups for confounding covariates, the median (IQR) time to recurrence in the dexamethasone group was 23 (6-46) compared with 18 (8-53) months in the control group (P = 0.63) with a median (95% confidence interval) difference of time to recurrence between the dexamethasone and the control group of 5 (-8 to 17) months.
  
  
  CONCLUSIONS
  We could not find evidence for an association between perioperative systemic dexamethasone administration and ovarian cancer recurrence after primary cytoreductive surgery. Our results do not support avoiding low-dose perioperative dexamethasone for prevention of postoperative nausea, vomiting, and pain in ovarian cancer patients.
authors.affiliation: From the *Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; †Department of Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio; and ‡Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Gildasio S
authors.initials: GS
authors.lastname: De Oliveira
authors.forename: Robert
authors.initials: R
authors.lastname: McCarthy
authors.forename: Alparsalan
authors.initials: A
authors.lastname: Turan
authors.forename: Julian C
authors.initials: JC
authors.lastname: Schink
authors.forename: Paul C
authors.initials: PC
authors.lastname: Fitzgerald
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
mesh_terms: D000368:Aged; D000932:Antiemetics / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010051:Ovarian Neoplasms / Q000209:etiology* / Q000601:surgery; D011182:Postoperative Care; D057216:Propensity Score; D012959:Socioeconomic Factors; D016896:Treatment Outcome
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents; D003907:Dexamethasone