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Open AccessReview

Long-Term Outcomes after Use of Perioperative Glucocorticoids in Patients Undergoing Cancer Surgery: A Systematic Review and Meta-Analysis

1
Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark
2
Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(1), 76; https://doi.org/10.3390/cancers12010076
Received: 27 November 2019 / Revised: 20 December 2019 / Accepted: 25 December 2019 / Published: 27 December 2019
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. View Full-Text
Keywords: oncoanaesthesiology; surgery; anesthesiology; cancer; perioperative treatment; steroids; corticosteroids; glucocorticoids; recurrence; survival oncoanaesthesiology; surgery; anesthesiology; cancer; perioperative treatment; steroids; corticosteroids; glucocorticoids; recurrence; survival
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Rosenkrantz Hölmich, E.; Petring Hasselager, R.; Tvilling Madsen, M.; Orhan, A.; Gögenur, I. Long-Term Outcomes after Use of Perioperative Glucocorticoids in Patients Undergoing Cancer Surgery: A Systematic Review and Meta-Analysis. Cancers 2020, 12, 76.

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