Intraoperative use of ketorolac or diclofenac is associated with improved disease-free survival and overall survival in conservative breast cancer surgery.
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.
Department of Anesthesiology, forgetpatrice@yahoo.fr.
P
P
Forget
Department of Gynecology, and.
C
C
Bentin
Department of Medical Oncology, Institut de Recherche Clinique et Expérimentale (pôle MIRO), Université catholique de Louvain, Brussels, Belgium.
J P
JP
Machiels
Department of Gynecology, and.
M
M
Berliere
de Duve Institute, Université catholique de Louvain, Brussels, Belgium.
P G
PG
Coulie
Department of Anesthesiology.
M
M
De Kock
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000097:blood / Q000601:surgery*; D004008:Diclofenac / Q000008:administration & dosage / Q000627:therapeutic use*; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D004341:Drug Evaluation / Q000379:methods; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D053208:Kaplan-Meier Estimate; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use*; D018655:Lymphocyte Count; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D020910:Ketorolac
conservative breast cancer surgery; neutrophil:lymphocyte ratio; non-steroidal anti-inflammatory drugs