Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2019

Open Access 01-12-2019 | Breast Cancer | Research article

Single dose of dexamethasone is not associated with postoperative recurrence and mortality in breast cancer patients: a propensity-matched cohort study

Authors: Myoung Hwa Kim, Dong Wook Kim, Seho Park, Joo Heung Kim, Ki Young Lee, Jisung Hwang, Young Chul Yoo

Published in: BMC Cancer | Issue 1/2019

Login to get access

Abstract

Background

Dexamethasone is widely used in cancer patients despite the concern that perioperative glucocorticoids may potentially cause immunosuppression. However, studies on the influence of dexamethasone on cancer recurrence after curative surgery have produced conflicting results. The goal of our study was to compare postoperative recurrence-free survival and overall survival between patients with breast cancer who received perioperative dexamethasone and those who did not.

Methods

The medical records of 2729 patients who underwent breast cancer surgery between November 2005 and December 2010 were reviewed. These patients were followed up until December 2015. The patients were categorised according whether they received a single dose of intravenous dexamethasone perioperatively or not. Cox regression analyses were conducted to evaluate any associations between dexamethasone usage with postoperative recurrence and mortality. Additionally, we performed a sensitivity test with propensity score matching to adjust for selection bias.

Results

Among the 2628 patients, 236 (8.5%) received perioperative dexamethasone. No increasing risk for recurrence (hazard ratio [HR], 1.442; 95% confidence interval [CI], 0.969–2.145; P = 0.071) or mortality (HR, 1.256; 95% CI, 0.770–2.047; P = 0.361) after breast cancer surgery were identified in patients who received dexamethasone. Similarly, propensity score matching did not show significant associations in postoperative recurrence (HR, 1.389; 95% CI, 0.904–2.132; P = 0.133) or mortality (HR, 1.506; 95% CI, 0.886–2.561; P = 0.130) in patients who received dexamethasone.

Conclusions

We found that a perioperative single dose of dexamethasone is not associated with increased recurrence or mortality after curative surgery in breast cancer patients.
Literature
1.
Holmgren L, O'Reilly MS, Folkman J. Dormancy of micrometastases: balanced proliferation and apoptosis in the presence of angiogenesis suppression. Nat Med. 1995;1(2):149–53.CrossRef
2.
Smyth MJ, Godfrey DI, Trapani JA. A fresh look at tumor immunosurveillance and immunotherapy. Nat Immunol. 2001;2(4):293–9.CrossRef
3.
Shakhar G, Ben-Eliyahu S. Potential prophylactic measures against postoperative immunosuppression: could they reduce recurrence rates in oncological patients? Ann Surg Oncol. 2003;10(8):972–92.CrossRef
4.
Kunicka JE, Talle MA, Denhardt GH, Brown M, Prince LA, Goldstein G. Immunosuppression by glucocorticoids: inhibition of production of multiple lymphokines by in vivo administration of dexamethasone. Cell Immunol. 1993;149(1):39–49.CrossRef
5.
Bush KA, Krukowski K, Eddy JL, Janusek LW, Mathews HL. Glucocorticoid receptor mediated suppression of natural killer cell activity: identification of associated deacetylase and corepressor molecules. Cell Immunol. 2012;275(1–2):80–9.CrossRef
6.
Holbrook NJ, Cox WI, Horner HC. Direct suppression of natural killer activity in human peripheral blood leukocyte cultures by glucocorticoids and its modulation by interferon. Cancer Res. 1983;43(9):4019–25.PubMed
7.
Chen YX, Wang Y, Fu CC, Diao F, Song LN, Li ZB, Yang R, Lu J. Dexamethasone enhances cell resistance to chemotherapy by increasing adhesion to extracellular matrix in human ovarian cancer cells. Endocr Relat Cancer. 2010;17(1):39–50.CrossRef
8.
De Oliveira GS Jr, Castro-Alves LJ, Ahmad S, Kendall MC, McCarthy RJ. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth Analg. 2013;116(1):58–74.CrossRef
9.
De Oliveira GS Jr, Ahmad S, Fitzgerald PC, Marcus RJ, Altman CS, Panjwani AS, McCarthy RJ. Dose ranging study on the effect of preoperative dexamethasone on postoperative quality of recovery and opioid consumption after ambulatory gynaecological surgery. Br J Anaesth. 2011;107(3):362–71.CrossRef
10.
Allemani C, Minicozzi P, Berrino F, Bastiaannet E, Gavin A, Galceran J, Ameijide A, Siesling S, Mangone L, Ardanaz E, et al. Predictions of survival up to 10 years after diagnosis for European women with breast cancer in 2000-2002. Int J Cancer. 2013;132(10):2404–12.CrossRef
11.
Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, Fitzgibbons PL, Francis G, Goldstein NS, Hayes M, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 2010;28(16):2784–95.CrossRef
12.
Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85(1):109–17.CrossRef
13.
Sekandarzad MW, van Zundert AAJ, Lirk PB, Doornebal CW, Hollmann MW. Perioperative anesthesia care and tumor progression. Anesth Analg. 2017;124(5):1697–708.CrossRef
14.
Heaney A, Buggy DJ. Can anaesthetic and analgesic techniques affect cancer recurrence or metastasis? Br J Anaesth. 2012;109(Suppl 1):i17–28.CrossRef
15.
Shakhar G, Abudarham N, Melamed R, Schwartz Y, Rosenne E, Ben-Eliyahu S. Amelioration of operation-induced suppression of marginating pulmonary NK activity using poly IC: a potential approach to reduce postoperative metastasis. Ann Surg Oncol. 2007;14(2):841–52.CrossRef
16.
Shakhar G, Blumenfeld B. Glucocorticoid involvement in suppression of NK activity following surgery in rats. J Neuroimmunol. 2003;138(1–2):83–91.CrossRef
17.
Li S, Mawal-Dewan M, Cristofalo VJ, Sell C. Enhanced proliferation of human fibroblasts, in the presence of dexamethasone, is accompanied by changes in p21Waf1/Cip1/Sdi1 and the insulin-like growth factor type 1 receptor. J Cell Physiol. 1998;177(3):396–401.CrossRef
18.
Ganguli G, Back J, Sengupta S, Wasylyk B. The p53 tumour suppressor inhibits glucocorticoid-induced proliferation of erythroid progenitors. EMBO Rep. 2002;3(6):569–74.CrossRef
19.
Langeveld CH, van Waas MP, Stoof JC, Sutanto W, de Kloet ER, Wolbers JG, Heimans JJ. Implication of glucocorticoid receptors in the stimulation of human glioma cell proliferation by dexamethasone. J Neurosci Res. 1992;31(3):524–31.CrossRef
20.
Freshney RI. Effects of glucocorticoids on glioma cells in culture. Minireview on cancer research. Exp Cell Biol. 1984;52(5):286–92.PubMed
21.
Guo WX, Antakly T. AIDS-related Kaposi's sarcoma: evidence for direct stimulatory effect of glucocorticoid on cell proliferation. Am J Pathol. 1995;146(3):727–34.PubMedPubMedCentral
22.
Yu HC, Luo YX, Peng H, Kang L, Huang MJ, Wang JP. Avoiding perioperative dexamethasone may improve the outcome of patients with rectal cancer. Eur J Surg Oncol. 2015;41(5):667–73.CrossRef
23.
Singh PP, Lemanu DP, Taylor MH, Hill AG. Association between preoperative glucocorticoids and long-term survival and cancer recurrence after colectomy: follow-up analysis of a previous randomized controlled trial. Br J Anaesth. 2014;113(Suppl 1):i68–73.CrossRef
24.
Merk BA, Havrilesky LJ, Ehrisman JA, Broadwater G, Habib AS. Impact of postoperative nausea and vomiting prophylaxis with dexamethasone on the risk of recurrence of endometrial cancer. Curr Med Res Opin. 2016;32(3):453–8.CrossRef
25.
De Oliveira GS Jr, McCarthy R, Turan A, Schink JC, Fitzgerald PC, Sessler DI. Is dexamethasone associated with recurrence of ovarian cancer? Anesth Analg. 2014;118(6):1213–8.CrossRef
26.
Call TR, Pace NL, Thorup DB, Maxfield D, Chortkoff B, Christensen J, Mulvihill SJ. Factors associated with improved survival after resection of pancreatic adenocarcinoma: a multivariable model. Anesthesiology. 2015;122(2):317–24.CrossRef
27.
Karaman K, Bostanci EB, Aksoy E, Ulas M, Yigit T, Erdemli MO, Ercin U, Bilgihan A, Saydam G, Akoglu M. Effects of dexamethasone and pheniramine hydrogen maleate on stress response in patients undergoing elective laparoscopic cholecystectomy. Am J Surg. 2013;205(2):213–9.CrossRef
28.
Cardinale F, Mastrototaro MF, Cappiello A, Caffarelli C, Caimmi S, Barberi S, Bernardini R. Immunological modifications induced from products used during the perioperative period. Int J Immunopathol Pharmacol. 2011;24(3 Suppl):S13–20.CrossRef
29.
Liu S, Wang B, Li S, Zhou Y, An L, Wang Y, Lv H, Zhang G, Fang F, Liu Z, et al. Immune cell populations decrease during craniotomy under general anesthesia. Anesth Analg. 2011;113(3):572–7.PubMed
30.
Khan S, Lopez-Dee Z, Kumar R, Ling J. Activation of NFkB is a novel mechanism of pro-survival activity of glucocorticoids in breast cancer cells. Cancer Lett. 2013;337(1):90–5.CrossRef
31.
Sorensen GV, Cronin-Fenton DP, Sorensen HT, Ulrichsen SP, Pedersen L, Lash TL. Use of glucocorticoids and risk of breast cancer: a Danish population-based case-control study. Breast Cancer Res. 2012;14(1):R21.CrossRef
32.
Lietzen LW, Ahern T, Christiansen P, Jensen AB, Sorensen HT, Lash TL, Cronin-Fenton DP. Glucocorticoid prescriptions and breast cancer recurrence: a Danish nationwide prospective cohort study. Ann Oncol. 2014;25(12):2419–25.CrossRef
Metadata
Title
Single dose of dexamethasone is not associated with postoperative recurrence and mortality in breast cancer patients: a propensity-matched cohort study
Authors
Myoung Hwa Kim
Dong Wook Kim
Seho Park
Joo Heung Kim
Ki Young Lee
Jisung Hwang
Young Chul Yoo
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2019
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-019-5451-5

Other articles of this Issue 1/2019

BMC Cancer 1/2019 Go to the issue

Research article

Verification of the effects of calcium channel blockers on the immune microenvironment of breast cancer

Research article

Treatment preferences of patients with relapsed and refractory multiple myeloma: a qualitative study

Research article

Long term follow-up of neoadjuvant chemotherapy for non-small cell lung cancer (NSCLC) investigating early positron emission tomography (PET) scan as a predictor of outcome

Research article

Body weight loss after surgery affects the continuity of adjuvant chemotherapy for pancreatic cancer

Review

A multi-disciplinary model of survivorship care following definitive chemoradiation for anal cancer

Research article

Sphere-forming culture enriches liver cancer stem cells and reveals Stearoyl-CoA desaturase 1 as a potential therapeutic target
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits