Postoperative Fever: The Potential Relationship with Prognosis in Node Negative Breast Cancer Patients

Abstract

BackgroundPostoperative fever may serve as an indirect sign to reflect the alterations of the host milieu caused by surgery. It still remains open to investigation whether postoperative fever has a bearing on prognosis in patients with lymph node negative breast cancers.MethodsWe performed a retrospective study of 883 female unilateral patients with lymph node negative breast cancer. Fever was defined as an oral temperature ≥38 in one week postoperation. Survival curves were performed with Kaplan-Meier method, and annual relapse hazard was estimated by hazard function.FindingsThe fever patients were older than those without fever (P<0.0001). Hypertensive patients had a propensity for fever after surgery (P = 0.011). A statistically significant difference was yielded in the incidence of fever among HR+/ERBB2-, ERBB2+, HR-/ERBB2- subgroups (P = 0.012). In the univariate survival analysis, we observed postoperative fever patients were more likely to recur than those without fever (P = 0.0027). The Cox proportional hazards regression analysis showed that postoperative fever (P = 0.044, RR = 1.89, 95%CI 1.02–3.52) as well as the HR/ERBB2 subgroups (P = 0.013, HR = 1.60, 95%CI 1.09–2.31) was an independent prognostic factor for relapse-free survival.ConclusionPostoperative fever may contribute to relapse in node negative breast cancer patients, which suggests that changes in host milieu related to fever might accelerate the growth of micro-metastatic foci. It may be more precise to integrate both tumor- and host-related factors for the evaluation of relapse risk.

The Impact of Surgical Complications on Cancer Recurrence Rates: A Literature Review

“…Similarly, we demonstrated that those who had a complication after immediate breast reconstructive surgery were more likely to develop breast cancer recurrence, both locally and distantly [23]. Yan et al [24] discovered that patients who have a fever in the post-operative period are more likely to develop breast cancer recurrence. Post-operative fever may indirectly reflect changes in host systemic factors.…”

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“…Similar evidence in breast cancer is limited; however, one study has suggested that delayed wound healing is associated with an increased rate of systemic recurrence after primary breast cancer surgery. In addition, patients who experience fever in the postoperative period are also more likely to develop breast cancer recurrence.…”

Impact of perioperative pain management on cancer recurrence: an ASRA/ESRA special article

“…Postoperative fever has been independently associated with increased recurrence (Relative Risk 1.89, 95% CI 1.02 to 3.52) 36. A possible mechanism is that fever-related host inflammatory response reduces eradication of neoplastic cells.…”