Survival Analysis of Patients with Breast Cancer Undergoing a Modified Radical Mastectomy With or Without a Thoracic Paravertebral Block: a 5-Year Follow-up of a Randomized Controlled Trial
| Autor: | Phoon Ping Chen, Anna Lee, Wing Cheong Chan, Winnie Samy, Manoj K. Karmakar, Ban C. H. Tsui, Jia Wei Li |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Time Factors Breast Neoplasms Modified Radical Mastectomy law.invention Metastasis 03 medical and health sciences Mastectomy Modified Radical 0302 clinical medicine Breast cancer Double-Blind Method Randomized controlled trial Risk Factors 030202 anesthesiology law medicine Risk of mortality Humans Paravertebral Block Prospective Studies 030212 general & internal medicine Neoplasm Metastasis Proportional Hazards Models Chi-Square Distribution business.industry Hazard ratio Nerve Block Perioperative Middle Aged medicine.disease Surgery Treatment Outcome Disease Progression Hong Kong Female Neoplasm Recurrence Local business Follow-Up Studies |
| Zdroj: | Anticancer Research. 37 |
| Popis: | Aim This 5-year prospective follow-up of women randomized to general anesthesia (GA) with or without a thoracic paravertebral block (TPVB) examined the risk of local recurrence, metastasis and mortality after breast cancer surgery. Patients and methods A total of 180 patients undergoing modified radical mastectomy were randomized to one of three study groups: standardized GA only; GA with a single-injection TPVB (s-TPVB) and placebo paravertebral infusion after surgery for 72-h; and GA plus with continuous TPVB (c-TPVB) for 72-h postoperatively. Cox proportional models were used to assess the effect of TPVB on long-term outcomes. Equivalence testing was used to help interpret the results. Results The incidence [95% confidence interval (CI)] of cancer recurrence, metastatic spread and all-cause mortality was 2.3% (0.7-5.4%), 7.9% (4.6-12.6%) and 6.8% (3.6-11.2%), respectively. Four women had cancer recurrence and had metastatic spread. Compared to the GA-only group, the risk of metastatic spread was not different from that of GA with s-TPVB [hazard ratio (HR)=1.11, 95% CI=0.32-3.83) nor from that with GA plus c-TPVB (HR=0.79, 95% CI=0.21-2.96) (p=0.88). Compared to the GA-only group, the risk of mortality was similarly not different from that of the two other groups (HR=2.57, 95% CI=0.66-9.92; and HR=0.66, 95% CI=0.11-3.97, respectively, p=0.15). Conclusion Although the original study was underpowered to properly address long-term outcomes, the results of this analysis suggest that TPVB, administered whether as a single-injection or continuous infusion during the perioperative period, had little to no appreciable effect on local recurrence, metastasis or mortality after breast cancer surgery. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|