Tramadol use is associated with enhanced postoperative outcomes in breast cancer patients: a retrospective clinical study with in vitro confirmation

Abstract

Background: There is growing interest in the effect of postoperative analgesics on oncological outcomes after cancer surgery. We investigated the impact of tramadol after breast cancer surgery on recurrence and mortality and explored the mechanism by which tramadol affects cultured breast cancer cells in vitro. Methods: Electronic medical records of patients who underwent breast cancer surgery between November 2005 and December 2010 at Severance Hospital in Korea were reviewed. Cox regression analyses were used to identify factors related to postoperative recurrence and mortality. We performed the sensitivity test with propensity score matching to adjust for selection bias. In addition, we investigated the effects of tramadol on human breast adenocarcinoma ) cells via assessment of cell viability, clonogenic assay, and cell cycle analysis in vitro. Results: Of 2588 breast cancer patients, 36.4% had received tramadol. Those who received tramadol had a 0.71-fold decreased risk of recurrence and a 0.56-fold decrease in mortality. The MCF-7 cell viability assays showed that tramadol had an anti-proliferative effect by cell cycle arrest, suppressing colony formation, and regulation of oestrogen and progesterone receptors. Tramadol induced apoptosis of MCF-7 cells via extracellular signal-regulated kinases by decreasing of 5-hydroxytryptamine (HT) 2B receptor and transient receptor potential vanilloid-1 expression. Conclusions: After breast cancer surgery, patients who received tramadol had a decreased risk of postoperative recurrence and mortality. The anti-tumour effect of tramadol appears to involve inhibition of proliferation, induction of apoptosis, and effects on 5-HT 2B receptor and TRPV-1.

Opioids and Breast Cancer Recurrence: A Systematic Review

“…Kim et al found that use of tramadol as a rescue analgesic after breast cancer surgery was associated with a decreased risk of postoperative disease recurrence rate (7.3% in the tramadol group vs. 9.4% in the control group) and lower mortality (4.7% vs. 8.1%, p = 0.001) [ 72 ].…”

Breast Cancer and Anaesthesia: Genetic Influence

“…Thereupon, Xia et al [ 42 ] demonstrated, in vitro, in breast tumor cells that tramadol reduces tumor cell proliferation, migration and invasion by up to 28 days through the inhibition of the α2-adrenergic receptor. In a retrospective study, Kim et al [ 43 ] observed lower rates of mortality and tumor recurrence in the group of breast cancer patients treated surgically who received tramadol. This effect is conferred by the inhibition of tumor cell proliferation, induction of apoptosis, and action on serotonergic receptors and transient receptor potential channel V1 or TRPV1.…”

Postoperative analgesic effect of parecoxib sodium local anesthesia in patients with breast cancer through systematic review and meta-analysis

“…According to research, there are many drugs that are used to treat the postoperative pain of breast cancer (25). The pre-administration of tramadol before radical mastectomy of breast cancer has been found to produce a good analgesic effect (26). Pregabalin combined with etoricoxib has a good analgesic effect, which can be used in the treatment of patients with pain after radical treatment of breast cancer, with few adverse reactions (27).…”