Valerie Catherine Linz, Marco Johannes Battista, Regina Hummel, Markus Schepers, Eva-Verena Griemert, Mona Wanda Schmidt, Marcus Schmidt, Annette Hasenburg, Katharina Gillen
{"title":"硬膜外麻醉对老年子宫内膜癌患者预后的影响——倾向评分匹配分析的结果。","authors":"Valerie Catherine Linz, Marco Johannes Battista, Regina Hummel, Markus Schepers, Eva-Verena Griemert, Mona Wanda Schmidt, Marcus Schmidt, Annette Hasenburg, Katharina Gillen","doi":"10.1159/000543540","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Epidural anesthesia is a standard procedure to mitigate pain during surgery for endometrial cancer (EC). Little data exist about the influence of epidural anesthesia on the oncological outcome in elderly patients with EC. This retrospective study aimed to investigate potential correlations between epidural anesthesia and cancer recurrence in patients with EC.</p><p><strong>Methods: </strong>We screened the medical records of patients ≥60 years treated surgically for EC at the University Medical Center Mainz between January 2008 and December 2019. All women underwent general anesthesia (GA) alone or combined with epidural anesthesia (EGA). Cox regression, the Kaplan-Meier method and propensity score matching were used to analyze the prognostic influence of the anesthesiologic regime on survival.</p><p><strong>Results: </strong>A total of 152 women with EC were included. Twenty-nine patients (19.1%) formed the EGA cohort. The median time of follow-up (FU) was 31 months (interquartile range [IQR]: 8-67.5). The EGA cohort showed more in-hospital complications (27.6 vs. 8.9%; p = 0.006), especially thromboembolic events (3 vs. 0 events; p = 0.006), as well as a longer hospital stay (11 [IQR: 8-13] vs. 7 [IQR: 4-9] days; p < 0.001). Twenty-six patients (17.1%) developed a recurrence in the follow-up at a median of 13 months [IQR: 7.75-29.5]. Thirty-two patients died during FU (21.1%). The EGA cohort showed higher FIGO stages and a higher histological grading than the GA cohort. In the Kaplan-Meier analysis, EGA showed a significantly reduced 5-year recurrence-free survival (RFS) (36.5% vs. 72.6%, p < 0.001) and overall survival (OS) (58.6% vs. 79.9%, p = 0.008). However, in multivariate Cox regression analysis including FIGO stages and histological grading, EGA did not influence RFS (HR: 2.02; 95%-CI: [0.99-4.12], p = 0.054), and OS (HR: 1.03; 95%-CI: [0.40-2.66], p = 0.951). This was backed up by the propensity score- matched analysis for survival (RFS: p = 0.604, OS: p = 0.86).</p><p><strong>Conclusion: </strong>Considering risk factors, epidural anesthesia in combination with GA did not differ in recurrence-free and overall survival compared to GA. Prospective randomized trials are warranted in order to further evaluate this topic.</p>","PeriodicalId":19543,"journal":{"name":"Oncology Research and Treatment","volume":" ","pages":"341-350"},"PeriodicalIF":1.6000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140583/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of Epidural Anesthesia on the Outcome of Elderly Patients with Endometrial Cancer: Results of a Propensity Score-Matched Analysis.\",\"authors\":\"Valerie Catherine Linz, Marco Johannes Battista, Regina Hummel, Markus Schepers, Eva-Verena Griemert, Mona Wanda Schmidt, Marcus Schmidt, Annette Hasenburg, Katharina Gillen\",\"doi\":\"10.1159/000543540\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Epidural anesthesia is a standard procedure to mitigate pain during surgery for endometrial cancer (EC). Little data exist about the influence of epidural anesthesia on the oncological outcome in elderly patients with EC. This retrospective study aimed to investigate potential correlations between epidural anesthesia and cancer recurrence in patients with EC.</p><p><strong>Methods: </strong>We screened the medical records of patients ≥60 years treated surgically for EC at the University Medical Center Mainz between January 2008 and December 2019. All women underwent general anesthesia (GA) alone or combined with epidural anesthesia (EGA). Cox regression, the Kaplan-Meier method and propensity score matching were used to analyze the prognostic influence of the anesthesiologic regime on survival.</p><p><strong>Results: </strong>A total of 152 women with EC were included. Twenty-nine patients (19.1%) formed the EGA cohort. The median time of follow-up (FU) was 31 months (interquartile range [IQR]: 8-67.5). The EGA cohort showed more in-hospital complications (27.6 vs. 8.9%; p = 0.006), especially thromboembolic events (3 vs. 0 events; p = 0.006), as well as a longer hospital stay (11 [IQR: 8-13] vs. 7 [IQR: 4-9] days; p < 0.001). Twenty-six patients (17.1%) developed a recurrence in the follow-up at a median of 13 months [IQR: 7.75-29.5]. Thirty-two patients died during FU (21.1%). The EGA cohort showed higher FIGO stages and a higher histological grading than the GA cohort. In the Kaplan-Meier analysis, EGA showed a significantly reduced 5-year recurrence-free survival (RFS) (36.5% vs. 72.6%, p < 0.001) and overall survival (OS) (58.6% vs. 79.9%, p = 0.008). However, in multivariate Cox regression analysis including FIGO stages and histological grading, EGA did not influence RFS (HR: 2.02; 95%-CI: [0.99-4.12], p = 0.054), and OS (HR: 1.03; 95%-CI: [0.40-2.66], p = 0.951). This was backed up by the propensity score- matched analysis for survival (RFS: p = 0.604, OS: p = 0.86).</p><p><strong>Conclusion: </strong>Considering risk factors, epidural anesthesia in combination with GA did not differ in recurrence-free and overall survival compared to GA. Prospective randomized trials are warranted in order to further evaluate this topic.</p>\",\"PeriodicalId\":19543,\"journal\":{\"name\":\"Oncology Research and Treatment\",\"volume\":\" \",\"pages\":\"341-350\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140583/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Oncology Research and Treatment\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000543540\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/25 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Oncology Research and Treatment","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000543540","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/25 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
简介:硬膜外麻醉是减轻子宫内膜癌(EC)手术期间疼痛的标准程序。硬膜外麻醉对老年EC患者肿瘤预后影响的研究资料很少。本回顾性研究旨在探讨硬膜外麻醉与EC患者癌症复发之间的潜在相关性。方法:我们筛选了2008年1月至2019年12月在美因茨大学医学中心接受手术治疗的≥60岁的EC患者的医疗记录。所有的妇女都接受了单独的全身麻醉(GA)或联合硬膜外麻醉(EGA)。采用Cox回归、Kaplan-Meier法和倾向评分匹配分析麻醉方案对生存的预后影响。结果:共纳入152例EC患者。29例患者(19.1%)形成EGA队列。中位随访时间(FU)为31个月[四分位间距(IQR): 8-67.5]。EGA组出现更多的院内并发症(27.6% vs 8.9%;P =0.006),尤其是血栓栓塞事件(3 vs 0事件;p=0.006),以及更长的住院时间(11 (IQR: 8-13)对7 (IQR: 4-9)天;结论:考虑危险因素,硬膜外麻醉联合GA与GA相比,在无复发和总生存率方面没有差异。为了进一步评估这一主题,前瞻性随机试验是必要的。
Impact of Epidural Anesthesia on the Outcome of Elderly Patients with Endometrial Cancer: Results of a Propensity Score-Matched Analysis.
Introduction: Epidural anesthesia is a standard procedure to mitigate pain during surgery for endometrial cancer (EC). Little data exist about the influence of epidural anesthesia on the oncological outcome in elderly patients with EC. This retrospective study aimed to investigate potential correlations between epidural anesthesia and cancer recurrence in patients with EC.
Methods: We screened the medical records of patients ≥60 years treated surgically for EC at the University Medical Center Mainz between January 2008 and December 2019. All women underwent general anesthesia (GA) alone or combined with epidural anesthesia (EGA). Cox regression, the Kaplan-Meier method and propensity score matching were used to analyze the prognostic influence of the anesthesiologic regime on survival.
Results: A total of 152 women with EC were included. Twenty-nine patients (19.1%) formed the EGA cohort. The median time of follow-up (FU) was 31 months (interquartile range [IQR]: 8-67.5). The EGA cohort showed more in-hospital complications (27.6 vs. 8.9%; p = 0.006), especially thromboembolic events (3 vs. 0 events; p = 0.006), as well as a longer hospital stay (11 [IQR: 8-13] vs. 7 [IQR: 4-9] days; p < 0.001). Twenty-six patients (17.1%) developed a recurrence in the follow-up at a median of 13 months [IQR: 7.75-29.5]. Thirty-two patients died during FU (21.1%). The EGA cohort showed higher FIGO stages and a higher histological grading than the GA cohort. In the Kaplan-Meier analysis, EGA showed a significantly reduced 5-year recurrence-free survival (RFS) (36.5% vs. 72.6%, p < 0.001) and overall survival (OS) (58.6% vs. 79.9%, p = 0.008). However, in multivariate Cox regression analysis including FIGO stages and histological grading, EGA did not influence RFS (HR: 2.02; 95%-CI: [0.99-4.12], p = 0.054), and OS (HR: 1.03; 95%-CI: [0.40-2.66], p = 0.951). This was backed up by the propensity score- matched analysis for survival (RFS: p = 0.604, OS: p = 0.86).
Conclusion: Considering risk factors, epidural anesthesia in combination with GA did not differ in recurrence-free and overall survival compared to GA. Prospective randomized trials are warranted in order to further evaluate this topic.
期刊介绍:
With the first issue in 2014, the journal ''Onkologie'' has changed its title to ''Oncology Research and Treatment''. By this change, publisher and editor set the scene for the further development of this interdisciplinary journal. The English title makes it clear that the articles are published in English – a logical step for the journal, which is listed in all relevant international databases. For excellent manuscripts, a ''Fast Track'' was introduced: The review is carried out within 2 weeks; after acceptance the papers are published online within 14 days and immediately released as ''Editor’s Choice'' to provide the authors with maximum visibility of their results. Interesting case reports are published in the section ''Novel Insights from Clinical Practice'' which clearly highlights the scientific advances which the report presents.