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

doi:10.3969/j.issn.1006-5725.2025.05.016

Abstract

Abstract:

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.

Key words: intraoperative, dexamethasone, non-small cell lung cancer, survival, propensity-score matching

CLC Number:

R971.2

Yang HUANG,Ge QU,Peizong WANG,Weian ZENG,Fang. YAN. Association between intraoperative dexamethasone and long-term survival in non-small cell lung cancer patients undergoing curative resection[J]. The Journal of Practical Medicine, 2025, 41(5): 724-730.

Figures/Tables 5

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References 30

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变量	非地米组（n = 532）	地米组（n = 283）	P 值
年龄/岁	59.57 ± 10.4	59.10 ± 10.5	0.461
性别/［例（%）］			0.599
女	214（40.2）	108（38.2）
男	318（59.8）	175（61.8）
BMI/（kg/m²）	22.99 ± 3.2	22.89 ± 3.2	0.643
ECOG/［例（%）］			0.165
0	357（67.1）	176（62.2）
1	175（32.9）	107（37.8）
并发症/［例（%）］	78（14.7）	36（12.7）	0.525
吸烟/［例（%）］	237（44.5）	112（39.6）	0.181
TNM分期/［例（%）］			0.434
Ⅰ	150（28.2）	69（24.4）
Ⅱ	117（22.0）	61（21.6）
Ⅲ	265（49.8）	153（54.1）
组织病理类型/［例（%）］			0.937
腺癌	363（68.2）	192（67.8）
非腺癌	169（31.8）	91（32.2）
肿瘤最大径/cm	3.47 ± 1.8	3.52 ± 1.8	0.601
ASA评分/［例（%）］			0.996
Ⅰ	88（16.5）	47（16.6）
Ⅱ	396（74.4）	210（74.2）
Ⅲ	48（9.0）	26（9.2）
麻醉方式/［例（%）］			0.900
吸入	520（97.7）	277（97.9）
静脉	12（2.3）	6（2.1）
麻醉时间/h	3.67 ± 1.6	3.92 ± 2.5	0.601
手术方式/［例（%）］			0.938
开胸	384（72.2）	205（72.4）
胸腔镜	148（27.8）	78（27.6）
手术种类/［例（%）］			0.735
楔形切除	43（8.1）	27（9.5）
肺叶切除	456（85.7）	237（83.7）
全肺切除	33（6.2）	19（6.7）
输血/［例（%）］	70（13.2）	31（11.0）	0.435
术后镇痛方式/［例（%）］			0.263
无	80（15.0）	32（11.3）
PCIA	380（71.4）	216（76.3）
PCEA	72（13.5）	35（12.4）
放疗/［例（%）］	102（19.2）	58（20.5）	0.645
化疗/［例（%）］			0.575
无	223（41.9）	118（41.7）
辅助	286（53.8）	147（51.9）
新辅助	7（1.3）	7（2.5）
辅助+新辅助	16（3.0）	11（3.9）

变量	HR	95% CI	P值
地塞米松	1.333	1.087～1.634	0.005
年龄（> 60岁）	1.131	0.926～1.381	0.229
性别	1.195	0.971～1.471	0.093
BMI	0.947	0.767～1.169	0.612
ECOG 1	3.418	2.787～4.191	< 0.001
并发症	1.204	0.916～1.583	0.183
吸烟	1.259	1.031～1.538	0.024
TNM晚期	1.535	1.353～1.742	< 0.001
组织病理类型	1.163	0.943～1.435	0.157
肿瘤最大径（> 3 cm）	0.836	0.684～1.023	0.082
ASA评分	1.244	1.014～1.525	0.036
麻醉方式	0.794	0.394～1.601	0.520
手术方式	1.026	0.819～1.287	0.822
手术类型	1.211	0.905～1.611	0.198
输血	1.291	0.966～1.725	0.084
术后镇痛方式	1.117	0.915～1.364	0.276
放疗	1.562	1.242～1.965	< 0.001
化疗	1.225	1.067～1.406	0.004

变量	HR	95% CI	P值
地塞米松	1.233	1.002～1.516	0.048
性别	1.052	0.845～1.310	0.649
ECOG 1	3.479	2.817～4.296	< 0.001
吸烟	1.321	1.068～1.633	0.010
TNM晚期	1.525	1.335～1.742	< 0.001
肿瘤最大径（> 3 cm）	0.896	0.730～1.101	0.296
ASA评分	1.011	0.823～1.241	0.920
输血	1.346	1.003～1.806	0.048
放疗	1.163	0.915～1.480	0.218
化疗	1.209	0.970～1.506	0.092

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Association between intraoperative dexamethasone and long-term survival in non-small cell lung cancer patients undergoing curative resection

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