Effect of steroid therapy on postoperative course and survival of patients with thoracic esophageal carcinoma

Abstract

Background. Perioperative steroid therapy has been shown to be safe and effective in inhibiting the production of inflammatory mediators and reducing postoperative hospital morbidity. However, there is limited information to show the effect of steroid therapy on long-term survival. In this study we evaluated the effect of perioperative steroid therapy on long-term survival of patients with thoracic esophageal cancer. Methods. Between 1993 and 2000, 141 consecutive patients with primary thoracic esophageal cancer underwent radical esophagectomy. A total of 78 patients who underwent surgery between 1997 and 2000 received perioperative steroid therapy. Sixty-three patients who underwent surgery between 1993 and 1996 were analyzed as the control group. In the steroid group, 250 mg methylprednisolone was administered intravenously just before surgery followed by 125 mg on postoperative days 1 and 2. The postoperative course and overall cause-specific survival rates were compared between the groups. Results. The postoperative hospital morbidity rate was significantly lower in the steroid group than in the control group. Although overall survival of the steroid group was better than the control group, cause-specific survival of both groups was similar. Multivariate analysis suggested that the depth of tumor and postoperative hospital morbidity were significant independent prognostic factors; however, steroid therapy was not statistically significant after adjusting for pathological variables. Conclusions. Perioperative steroid therapy may improve the postoperative course but does not improve the longterm survival of patients with thoracic esophageal cancer.

Long-Term Outcomes after Use of Perioperative Glucocorticoids in Patients Undergoing Cancer Surgery: A Systematic Review and Meta-Analysis

“…The included studies reported on a variety of eight cancer types: pancreatic adenocarcinoma [19,28], non-small-cell lung cancer [20,23,34], ovarian [21], rectal [22,33], colorectal [25,31], endometrial [26], oesophageal [27,29,30,32], and breast cancer [24]. Sample sizes range from 37 [27] to 2628 [24] patients and the follow-up periods from six months to ten years.…”

“…One of these was analysed as two separate studies, and will be referred to as two studies, because the participants were divided into two study populations according to lymph node dissemination [25]. Fifteen studies reported OS [19,20,[22][23][24][25][26][27][28][29][30][31][32][33] and seven studies reported DFS [20,23,26,[31][32][33][34]. Several studies reported recurrence-free survival or progression-free survival; however, this definition was in accordance with our predetermined definition of DFS and was analysed as such.…”

“…One of the studies did not report any extractable data and was left out of the meta-analysis [22]. Only one study reported CSS [30], and a meta-analysis could not be performed for this outcome.…”

“…Four of the included studies were randomised controlled trials [22,29,31,32] (one of these was the study not included in the meta-analysis [22]) and the remaining twelve were retrospective cohort studies. Eleven studies found no association between the use of perioperative glucocorticoids and any of our outcomes [21,22,[24][25][26][27][29][30][31][32]; four studies found associations in favour of glucocorticoids [19,23,28,34]; and two studies found associations in favour of the control group [20,33] (see Supplementary Material, Table S4 for all study results).…”

“…Of the five studies eligible for the recurrence analyses, three had a low risk of bias [21,24,26]; two a medium risk of bias [25]; and one study was a randomised trial with almost entirely unclear risk of bias [32]. In the OS analyses, six non-randomised studies had a low risk of bias [19,20,23,24,26,33], and five had a medium risk [25,27,28,30]. Of the eligible randomised trials, one had an unclear risk of bias [32] and two had a low risk [29,31].…”