Perioperative Use of Nonsteroidal Anti-inflammatory Drugs Decreases the Risk of Recurrence of Cancer After Colorectal Resection: A Cohort Study Based on Prospective Data

Schack, Anders; Fransgaard, Tina; Klein, Mads; Gögenur, Ismail

doi:10.1245/s10434-019-07600-8

Cited by 26 publications

(17 citation statements)

References 35 publications

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“…LDH is recently emerging as an anticancer target 45,46 . Herein, we postulate that the perioperative use of nonsteroidal anti‐inflammatory drugs might decrease the recurrence risk of CRLM resection 47 …”

Section: Discussionmentioning

confidence: 99%

The prognostic value of preoperative serum lactate dehydrogenase levels in patients underwent curative‐intent hepatectomy for colorectal liver metastases: A two‐center cohort study

Bai

Lin

et al. 2021

Cancer Medicine

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Background The prognostic value of lactate dehydrogenase (LDH) in colorectal cancer patients has remained inconsistent between nonmetastatic and metastatic settings. So far, very few studies have included LDH in the prognostic analysis of curative‐intent surgery for colorectal liver metastases (CRLM). Patients and Methods Five hundred and eighty consecutive metastatic colorectal cancer patients who underwent curative‐intent CRLM resection from Sun Yat‐sen University Cancer Center (434 patients) and Sun Yat‐sen University Sixth Affiliated Hospital (146 patients) in 2000–2019 were retrospectively collected. Overall survival (OS) was the primary end point. Cox regression model was performed to identify the prognostic values of preoperative serum LDH levels and other clinicopathology variables. A modification of the established Fong CRS scoring system comprising LDH was developed within this Chinese population. Results At the median follow‐up time of 60.5 months, median OS was 59.5 months in the pooled cohort. In the multivariate analysis, preoperative LDH >upper limit of normal (250 U/L) was the strongest independent prognostic factor for OS (HR 1.73, 95% confidence interval [CI], 1.22–2.44; p < 0.001). Patients with elevated LDH levels showed impaired OS than patients with normal LDH levels (27.6 months vs. 68.8 months). Five‐year survival rates were 53.7% and 22.5% in the LDH‐normal group and LDH‐high group, respectively. Similar results were also confirmed in each cohort. In the subgroup analysis, LDH could distinguish the survival regardless of most established prognostic factors (number and size of CRLM, surgical margin, extrahepatic metastases, CEA, and CA19‐9 levels, etc.). Integrating LDH into the Fong score contributed to an improvement in the predictive value. Conclusion Our study implicates serum LDH as a reliable and independent laboratory biomarker to predict the clinical outcome of curative‐intent surgery for CRLM. Composite of LDH and Fong score is a potential stratification tool for CRLM resection. Prospective, international studies are needed to validate these results across diverse populations.

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Section: Discussionmentioning

confidence: 99%

The prognostic value of preoperative serum lactate dehydrogenase levels in patients underwent curative‐intent hepatectomy for colorectal liver metastases: A two‐center cohort study

Bai

Lin

et al. 2021

Cancer Medicine

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“…LDH may serve as an alternative indicator of systemic in ammation and immunosuppression. Herein, we postulate that perioperative use of nonsteroidal ani-in ammatory drugs to reduce in ammation may decrease the risk of recurrence following hepatectomy [45].…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Value of Preoperative Serum Lactate Dehydrogenase (LDH) Levels in Patients Underwent Curative-intent Hepatectomy For Colorectal Liver Metastases: A Two-Center Cohort Study

Bai

Lin

et al. 2021

Preprint

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Background: The prognostic value of lactate dehydrogenase (LDH) in colorectal cancer patients has remained inconsistent between non-metastatic and metastatic settings. So far very few studies have included LDH in prognostic analysis for patients with colorectal liver metastases (CRLM) who underwent curative-intent hepatectomy. Patients and Methods: Consecutive metastatic colorectal cancer patients who underwent curative-intent resection for CRLM from two Chinese medical centers treated in 2000-2019 were enrolled in the training cohort (434 patients) and the validation cohort (146 patients). Overall survival (OS) was the primary endpoint. Cox regression model was performed to identify the prognostic values of LDH and other clinicopathology variables. A modification of the established Fong scoring system comprising LDH was developed within this Chinese population.Results: In the training cohort, preoperative LDH > upper limit of normal (ULN) was the strongest independent prognostic factor both for RFS (HR 2.11, 95% confidence intervals [CIs], 1.54-2.89; P < .001) and OS (HR 2.41, 95% CI, 1.72-3.39; P < .001) in multivariate analysis. 5-year survival rates were 23.7% and 52.9% in the LDH > ULN group and LDH < ULN group, respectively. These data were also confirmed in the validation cohort and then in pooled cohort. Replacing carcinoembryonic antigen (CEA) with LDH in the Fong score contributed to an improvement in the predictive value.Conclusions: Preoperative serum LDH is a reliable and independent predictor for curative-intent CRLM resection. Composite of LDH and Fong score is a potential stratification tool for CRLM resection.

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“…However, these observational and retrospective studies claim a reduced recurrence rate, longer disease-free survival, or overall survival due to the effects of perioperative NSAIDs. [104][105][106][107][108][109][110][111][112] In conclusion, despite the positive effect of NSAIDs in epidemiologic studies, immune-based perioperative antitumor effects, and positive observational and retrospective studies, there is insufficient or inconclusive evidence from high-quality clinical studies to support the experimental data (studies are summarized in table 2).…”

Section: Tumor Growth and Metastasismentioning

confidence: 99%

Immune Modulatory Effects of Nonsteroidal Anti-inflammatory Drugs in the Perioperative Period and Their Consequence on Postoperative Outcome

et al. 2022

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Nonsteroidal anti-inflammatory drugs are among the most commonly administered drugs in the perioperative period due to their prominent role in pain management. However, they potentially have perioperative consequences due to immune-modulating effects through the inhibition of prostanoid synthesis, thereby affecting the levels of various cytokines. These effects may have a direct impact on the postoperative outcome of patients since the immune system aims to restore homeostasis and plays an indispensable role in regeneration and repair. By affecting the immune response, consequences can be expected on various organ systems. This narrative review aims to highlight these potential immune system–related consequences, which include systemic inflammatory response syndrome, acute respiratory distress syndrome, immediate and persistent postoperative pain, effects on oncological and neurologic outcome, and wound, anastomotic, and bone healing.

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Perioperative Use of Nonsteroidal Anti-inflammatory Drugs Decreases the Risk of Recurrence of Cancer After Colorectal Resection: A Cohort Study Based on Prospective Data

Cited by 26 publications

References 35 publications

The prognostic value of preoperative serum lactate dehydrogenase levels in patients underwent curative‐intent hepatectomy for colorectal liver metastases: A two‐center cohort study

The prognostic value of preoperative serum lactate dehydrogenase levels in patients underwent curative‐intent hepatectomy for colorectal liver metastases: A two‐center cohort study

The Prognostic Value of Preoperative Serum Lactate Dehydrogenase (LDH) Levels in Patients Underwent Curative-intent Hepatectomy For Colorectal Liver Metastases: A Two-Center Cohort Study

Immune Modulatory Effects of Nonsteroidal Anti-inflammatory Drugs in the Perioperative Period and Their Consequence on Postoperative Outcome

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