Impact of Anesthetic Factors on Prognosis of Patients with Non-small Cell Lung Cancer After Surgery

Background: Nowadays, the influence of anesthesia management on the prognosis of cancer patients has been widely concerned. The goal of this study is to assess the association between anesthetic factors and the prognosis of patients with non-small cell lung cancer (NSCLC) after surgery.

Methods: Patients with NSCLC who underwent surgery from January 1, 2006, to December 31, 2009 were selected. Cox proportional hazards model and Logistic regression analysis model were used to screen the independent predictors of prognosis of patients. The primary endpoint was postoperative overall survival (OS), and the secondary endpoint was postoperative recurrence-free survival (RFS) and postoperative pulmonary complications (PPCs).

Results: A total of 588 patients were included into the final analysis. The overall RFS was 4.4 [interquartile range (IQR), 1.1-10.1] years, and the OS was 6.2 (IQR, 2.4-10.2) years. Age ≥60 years, advanced tumor stage, and maximal tumor size >3 cm were associated with shortened survival, whereas high BMI grade, mediastinal lymph node dissection, perioperative fentanyl equivalents >28.2 µg/kg, and high tumor grade were associated with prolonged survival (P<0.05); perioperative glucocorticoid administration delayed recurrence (P<0.05); advanced tumor stage and perioperative fentanyl equivalents >28.2 µg/kg were associated with an increased PPCs risk (P<0.05).

Conclusions: The findings from this study revealed that perioperative anesthetic factors may impact the prognosis of patients with NSCLC after surgery. Perioperative opioid and glucocorticoid exposure were independent predictors for outcomes. However, perioperative fentanyl equivalents over 28.2 µg/kg seemed to be beneficial to OS, but contribute to the occurrence of PPCs.