Opioids and premature biochemical recurrence of prostate cancer: a randomised prospective clinical trial

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorRANGEL, Felipe P.
dc.contributor.authorJR, Jose O. C. Auler
dc.contributor.authorCARMONA, Maria J. C.
dc.contributor.authorCORDEIRO, Mauricio D.
dc.contributor.authorNAHAS, William C.
dc.contributor.authorCOELHO, Rafael F.
dc.contributor.authorSIMOES, Claudia M.
dc.date.accessioned2021-06-17T13:49:38Z
dc.date.available2021-06-17T13:49:38Z
dc.date.issued2021
dc.description.abstractBackground: Prostate cancer is one of the most prevalent neoplasms in male patients, and surgery is the main treatment. Opioids can have immune modulating effects, but their relation to cancer recurrence is unclear. We evaluated whether opioids used during prostatectomy can affect biochemical recurrence-free survival. Methods: We randomised 146 patients with prostate cancer scheduled for prostatectomy into opioid-free anaesthesia or opioid-based anaesthesia groups. Baseline characteristics, perioperative data, and level of prostate-specific antigen every 6 months for 2 yr after surgery were recorded. Prostate-specific antigen >0.2 ng ml(-1) was considered biochemical recurrence. A survival analysis compared time with biochemical recurrence between the groups, and a Cox regression was modelled to evaluate which variables affect biochemical recurrence-free survival. Results: We observed 31 biochemical recurrence events: 17 in the opioid-free anaesthesia group and 14 in the opioidbased anaesthesia group. Biochemical recurrence-free survival was not statistically different between groups (P=0.54). Cox regression revealed that biochemical recurrence-free survival was shorter in cases of obesity (hazard ratio [HR] 1.63, confidence interval [CI] 0.16-3.10; p=0.03), high D'Amico risk (HR 1.58, CI 0.35-2.81; P=0.012), laparoscopic surgery (HR 1.6, CI 0.38-2.84; P=0.01), stage 3 tumour pathology (HR 1.60, CI 0.20-299) and N1 status (HR 1.34, CI 0.28-2.41), and positive surgical margins (HR 1.37, CI 0.50-2.24; P=0.002). The anaesthesia technique did not affect time to biochemical recurrence (HR -1.03, CI -2.65-0.49; P=0.18). Conclusions: Intraoperative opioid use did not modify biochemical recurrence rates and biochemical recurrence-free survival in patients with intermediate and high D?Amico risk prostate cancer undergoing radical prostatectomy. Clinical trial registration: NCT03212456.eng
dc.description.indexMEDLINEeng
dc.identifier.citationBRITISH JOURNAL OF ANAESTHESIA, v.126, n.5, p.931-939, 2021
dc.identifier.doi10.1016/j.bja.2021.01.031
dc.identifier.eissn1471-6771
dc.identifier.issn0007-0912
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/40508
dc.language.isoeng
dc.publisherELSEVIER SCI LTDeng
dc.relation.ispartofBritish Journal of Anaesthesia
dc.rightsrestrictedAccesseng
dc.rights.holderCopyright ELSEVIER SCI LTDeng
dc.subjectbiochemical recurrenceeng
dc.subjectcancer recurrenceeng
dc.subjectmultimodal analgesiaeng
dc.subjectopioideng
dc.subjectopioid-free anaesthesiaeng
dc.subjectprostatectomyeng
dc.subjectprostate cancereng
dc.subject.otherradical prostatectomyeng
dc.subject.otherreceptor expressioneng
dc.subject.otherprognostic valueeng
dc.subject.otherpain managementeng
dc.subject.otheranesthesiaeng
dc.subject.otherdecreaseeng
dc.subject.otheroutcomeseng
dc.subject.othersurgeryeng
dc.subject.wosAnesthesiologyeng
dc.titleOpioids and premature biochemical recurrence of prostate cancer: a randomised prospective clinical trialeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.citation.scopus13
hcfmusp.contributor.author-fmusphcFELIPE PORTO RANGEL
hcfmusp.contributor.author-fmusphcJOSE OTAVIO COSTA AULER JUNIOR
hcfmusp.contributor.author-fmusphcMARIA JOSE CARVALHO CARMONA
hcfmusp.contributor.author-fmusphcMAURICIO DENER CORDEIRO
hcfmusp.contributor.author-fmusphcWILLIAM CARLOS NAHAS
hcfmusp.contributor.author-fmusphcRAFAEL FERREIRA COELHO
hcfmusp.contributor.author-fmusphcCLAUDIA MARQUEZ SIMOES
hcfmusp.description.beginpage931
hcfmusp.description.endpage939
hcfmusp.description.issue5
hcfmusp.description.volume126
hcfmusp.origemWOS
hcfmusp.origem.pubmed33712224
hcfmusp.origem.scopus2-s2.0-85102297513
hcfmusp.origem.wosWOS:000641041700015
hcfmusp.publisher.cityOXFORDeng
hcfmusp.publisher.countryENGLANDeng
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