Intraoperative use of ketorolac or diclofenac is associated with improved disease-free survival and overall survival in conservative breast cancer surgery

• Published in: British journal of anaesthesia : BJA Vol. 113; no. suppl_1; pp. i82 - i87
• Main Authors: Forget, P., Bentin, C., Machiels, J.-P., Berliere, M., Coulie, P.G., De Kock, M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2014; Oxford University Press
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Breast Neoplasms - blood; Breast Neoplasms - surgery; conservative breast cancer surgery; Diclofenac - administration & dosage; Diclofenac - therapeutic use; Disease-Free Survival; Drug Administration Schedule; Drug Evaluation - methods; Female; Humans; Intraoperative Care - methods; Kaplan-Meier Estimate; Ketorolac - administration & dosage; Ketorolac - therapeutic use; Lymphocyte Count; Mastectomy, Segmental; Middle Aged; neutrophil:lymphocyte ratio; Neutrophils - pathology; non-steroidal anti-inflammatory drugs; Prognosis; Retrospective Studies; Treatment Outcome; conservative breast cancer surgery; non-steroidal anti-inflammatory drugs; neutrophil:lymphocyte ratio
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aet464

An association between the use of non-steroidal anti-inflammatory drugs (NSAIDs) and better outcome after mastectomy and lung surgery for cancer has been recently suggested. In a retrospective analysis, we investigated the association between intraoperative NSAIDs use in conservative breast cancer surgery and breast cancer disease-free survival (DFS). Similarly, we also evaluated the association between breast cancer DFS and preoperative neutrophil:lymphocyte ratio (NLR).
A retrospective analysis of a single-centre cohort was performed in breast cancer patients (n=720) with uni- and multivariate analyses, using a Cox regression model.
In conservative breast cancer surgery, the intraoperative use of NSAIDs (ketorolac or diclofenac) was associated with an improved DFS {hazard ratio (HR)=0.57 [95% confidence interval (CI): 0.37–0.89], P=0.01} and an improved overall survival (OS) [HR=0.35 (95% CI: 0.17–0.70), P=0.03]. In these patients, an NLR >3.3 (identified by a receiver-operating characteristic curve) was associated with a shorter DFS [HR=1.99 (95% CI: 1.16–3.41), P=0.01] and OS [HR=2.35 (95% CI: 1.02–5.43), P=0.046].
Intraoperative NSAIDs and higher preoperative NLR are associated with improved outcome in conservative breast cancer surgery. Prospective, randomized trials to evaluate if these associations are causal are warranted.