Objective: 

We examined the effects of dexamethasone on postoperative mortality, recurrence-free survival, and side effects in patients undergoing oncologic operations.

Background: 

Dexamethasone prevents nausea and vomiting after anesthesia and may affect cancer proliferation.

Methods: 

A total of 30,561 adult patients undergoing solid cancer resection between 2005 and 2020 were included. Multivariable logistic regression was applied to investigate the effect of dexamethasone on 1-year mortality and recurrence-free survival. Effect modification by cancer’s potential for immunogenicity, defined as a recommendation for checkpoint inhibitor therapy based on the National Comprehensive Cancer Network guidelines, was investigated through interaction term analysis. Key safety endpoints were dexamethasone-associated risk of hyperglycemia >180 mg/dL within 24 hours and surgical site infections within 30 days after surgery.

Results: 

Dexamethasone was administered to 38.2% (11,666/30,561) of patients (6.5±2.3 mg). Overall, 3.2% (n=980/30,561) died and 15.4% (n=4718/30,561) experienced cancer recurrence within 1 year of the operation. Dexamethasone was associated with a −0.6% (95% confidence interval: −1.1, −0.2, P=0.007) 1-year mortality risk reduction [adjusted odds ratio (OR_adj): 0.79 (0.67, 0.94), P=0.009; hazard ratio=0.82 (0.69, 0.96), P=0.016] and higher odds of recurrence-free survival [OR_adj: 1.28 (1.18, 1.39), P<0.001]. This effect was only present in patients with solid cancers who were defined as not to respond to checkpoint inhibitor therapy [OR_adj: 0.70 (0.57, 0.87), P=0.001 vs OR_adj: 1.13 (0.85, 1.50), P=0.40]. A high (>0.09 mg/kg) dose of dexamethasone increased the risk of postoperative hyperglycemia [OR_adj: 1.55 (1.32, 1.82), P<0.001], but not for surgical site infections [OR_adj: 0.84 (0.42, 1.71), P=0.63].

Conclusions: 

Dexamethasone is associated with decreased 1-year mortality and cancer recurrence in patients undergoing surgical resection of cancers that are not candidates for immune modulators. Dexamethasone increased the risk of postoperative hyperglycemia, however, no increase in surgical site infections was identified.

中文翻译：

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接受肿瘤手术的患者术中地塞米松与术后死亡率之间的关联：一项多中心队列研究

客观的： 

我们研究了地塞米松对接受肿瘤手术的患者术后死亡率、无复发生存率和副作用的影响。

背景： 

地塞米松可防止麻醉后恶心和呕吐，并可能影响癌症增殖。

方法： 

共有 30,561 名 2005 年至 2020 年间接受实体癌切除术的成年患者纳入研究。应用多变量逻辑回归研究地塞米松对 1 年死亡率和无复发生存率的影响。通过相互作用项分析研究了癌症潜在免疫原性的效果修改，定义为基于国家综合癌症网络指南的检查点抑制剂治疗建议。关键安全终点是地塞米松相关的 24 小时内高血糖 >180 mg/dL 的风险以及术后 30 天内手术部位感染的风险。

结果： 

38.2% (11,666/30,561) 的患者服用了地塞米松 (6.5±2.3 mg)。总体而言，手术后 1 年内，3.2% (n=980/30,561) 的患者死亡，15.4% (n=4718/30,561) 的癌症复发。地塞米松与-0.6%（95%置信区间：-1.1，-0.2，P =0.007）1年死亡率风险降低相关[调整后的比值比（OR _adj）：0.79（0.67，0.94），P =0.009；风险比=0.82（0.69，0.96），P =0.016]和更高的无复发生存率[OR _adj：1.28（1.18，1.39），P <0.001]。这种效应仅存在于被定义为对检查点抑制剂治疗无反应的实体癌患者中 [OR _adj : 0.70 (0.57, 0.87), P =0.001 vs OR _adj : 1.13 (0.85, 1.50), P =0.40] 。高剂量 (>0.09 mg/kg) 地塞米松会增加术后高血糖的风险 [OR _adj : 1.55 (1.32, 1.82), P <0.001]，但不会增加手术部位感染的风险 [OR _adj : 0.84 (0.42, 1.71) ，P =0.63]。

结论： 

对于接受手术切除不适合免疫调节剂的癌症的患者来说，地塞米松可降低 1 年死亡率和癌症复发率。地塞米松增加了术后高血糖的风险，但未发现手术部位感染增加。