收稿日期: 2025-01-09
网络出版日期: 2025-03-20
基金资助
国家自然科学基金面上项目(82172843)
Association between intraoperative dexamethasone and long-term survival in non-small cell lung cancer patients undergoing curative resection
Received date: 2025-01-09
Online published: 2025-03-20
目的 探讨术中使用地塞米松是否会影响非小细胞肺癌患者长期生存。 方法 回顾性收集1 629例自2008年1月至2014年12月行肺癌根治术的非小细胞肺癌患者的病例资料。以1∶2的比例产生倾向性评分匹配分析队列，分别为283例术中使用地塞米松组和532例术中未使用地塞米松组。Kaplan-Meier法比较两组患者的无病生存时间和总生存时间，多因素cox回归模型验证在术后恶心呕吐（PONV）高危因素亚组中术中地塞米松和生存时间的关系。 结果 术中使用地塞米松可缩短患者的总生存时间（P = 0.005），而无病生存时间不受影响（P = 0.121）。多因素cox回归模型显示术中使用地塞米松为总生存时间的独立预后因素（HR = 1.233，95%CI：1.002 ~ 1.516，P = 0.048）。在PONV高危因素亚组中，女性、胸腔镜、麻醉时间长和使用吸入麻醉药亚组术中使用地塞米松与更差的总生存时间显著相关。 结论 术中使用地塞米松可能会缩短非小细胞肺癌术后患者的总生存时间，而对无病生存时间没有影响。而对于女性、胸腔镜、麻醉时间长和使用吸入麻醉药的患者，术中使用地塞米松可能会导致更短的总生存时间。
黄洋 , 屈舸 , 王培宗 , 曾维安 , 闫芳 . 术中使用地塞米松对非小细胞肺癌患者术后长期生存的影响[J]. 实用医学杂志, 2025 , 41(5) : 724 -730 . DOI: 10.3969/j.issn.1006-5725.2025.05.016
Objective To investigate the association between intraoperative dexamethasone administration and long-term survival outcomes. Methods A total of 1 629 NSCLC patients who underwent lung tumor resection between January 2008 and December 2014 were included in this study. A propensity score-matched cohort was generated at a ratio of 1∶2 to compare patients who received dexamethasone with those who did not. This matching process resulted in a cohort of 532 patients in the non-DEX group and 283 patients in the DEX group. Within this propensity score-matched cohort， disease-free survival （DFS） and overall survival （OS） were compared between the non-DEX and DEX groups using the Kaplan?Meier method. Additionally， Cox proportional hazards regression analysis was used to evaluate the associations between intraoperative administration of dexamethasone and high-risk factors for postoperative nausea and vomiting （PONV）， as well as their impact on DFS and OS. Results After propensity score matching， intraoperative dexamethasone was significantly associated with worse OS （P = 0.005）， while no significant correlation was observed between intraoperative dexamethasone and DFS. Multivariate Cox regression analyses indicated that intraoperative dexamethasone was associated with poorer overall survival （HR =1.233， 95% CI： 1.002 ~ 1.516， P = 0.048）. In subgroup analyses， intraoperative dexamethasone was significantly associated with shorter OS in the female， video-assisted thoracoscopic surgery （VATS）， prolonged anesthetic time， and inhalation anesthesia subgroups. Conclusions There was a significant correlation between intraoperative dexamethasone administration and overall survival in NSCLC patients following curative surgery. In high-risk subgroups for PONV， including females， those undergoing VATS， patients with prolonged anesthetic duration， and those under inhalation anesthesia， the administration of intraoperative dexamethasone was associated with a potentially poorer prognosis compared to patients who did not receive intraoperative dexamethasone.
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