Key result
Perioperative glucocorticoids show no association with cancer recurrence after surgery.
Why the study?
The surgical stress response can accelerate clinical metastasis formation, and perioperative glucocorticoids might modulate this response and the metastatic process.
Do perioperative glucocorticoids affect recurrence and survival in patients undergoing cancer surgery?
Meta-Analysis
Do perioperative glucocorticoids affect recurrence and survival in patients undergoing cancer surgery?
Perioperative glucocorticoids do not appear to be associated with cancer recurrence, though current evidence is heterogenous and of low quality.
Answers are grounded in this paper and cite their sources.
Perioperative glucocorticoids show no association with long-term cancer outcomes; confirms safety across eight tumor types but leaves dosing and timing open.
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.
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Hölmich et al. (2019) conducted a meta-analysis in Cancer. Perioperative glucocorticoids vs. No perioperative glucocorticoids was evaluated on Recurrence (RR 1.04, 95% CI 0.87-1.25). Perioperative glucocorticoids were not associated with recurrence after cancer surgery (RR 1.04, 95% CI 0.87-1.25).
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