Abstract
The surgical stress response can accelerate clinical metastasis formation. Perioperative glucocorticoids might modulate this response and the metastatic process. We aimed to describe associations between perioperative glucocorticoids and long-term outcomes after cancer surgery. We searched four databases for eligible trials and performed meta-analyses on frequency and time-to-event data. We included sixteen studies that evaluated eight different cancer types. No association was found between perioperative glucocorticoids and recurrence in either the frequency meta-analysis, risk ratio (RR) 1.04, 95% confidence interval (CI) (0.87–1.25), or in the time-to-event meta-analysis, hazard ratio (HR) 1.18, 95% CI (0.78–1.79). Increased 1-year overall survival, RR 0.70, 95% (0.51–0.97), and disease-free survival, RR 0.77, 95% CI (0.60–0.97), was found for the glucocorticoid group, but five years after surgery, overall survival was reduced for the glucocorticoid group, RR 1.64, 95% CI (1.00–2.71). An exploratory subgroup analysis revealed decreased overall survival, HR 1.78, 95% CI (1.57–2.03), for patients undergoing colorectal cancer surgery while receiving glucocorticoids. Perioperative glucocorticoids were not associated with recurrence after cancer surgery. We found neither beneficial or deleterious associations between glucocorticoids and overall survival or disease-free survival. The available evidence remains heterogenous; low in quality and amount; and cancer-specific at present.
Highlights
The global disease burden of cancer is considerable with as much as 18 million new cases annually, and more than half as many mortalities in 2018
We aimed to describe the possible association between perioperative glucocorticoids and long-term outcomes for patients undergoing cancer surgery
After duplicates removed andbe screening done, were included in the4886 systematic review. One ofwere these could not screening was done, 16 studies were included in the systematic review
Summary
The global disease burden of cancer is considerable with as much as 18 million new cases annually, and more than half as many mortalities in 2018. The majority of cancer deaths are caused by metastases [1], and the numbers are expected to nearly double in 2040 [2]. Surgical resection remains the primary curative treatment of solid cancers. This intervention induces a stress response that can contribute to the formation of clinical metastases, mainly by changes in immunological function and tumour microenvironment [3,4]. Because inflammatory processes are associated with tumour growth, the surgically induced metastatic spread could possibly be altered by using perioperative immunomodulatory drugs
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
