Impact of postoperative nausea and vomiting prophylaxis with dexamethasone on the risk of recurrence of endometrial cancer

Abstract

Objective: To assess whether antiemetic doses of dexamethasone are associated with an increased risk of cancer recurrence in women who underwent surgery for endometrial cancer.

Research design and methods: This is a retrospective study at an academic university medical center. Women who underwent surgery for endometrial cancer from 2003 to 2007 were identified from a prospectively collected endometrial cancer database. Perioperative records were reviewed to determine administration of dexamethasone. Patients were divided into two groups: those who received dexamethasone 4-10 mg for postoperative nausea and vomiting prophylaxis and those who did not receive dexamethasone. We collected information on patient demographics, cancer stage, cancer grade, histology, year of surgery, chemotherapy, radiation therapy, duration of surgery, perioperative blood transfusion, receipt of epidural analgesia, dose of dexamethasone given, follow-up time, and co-morbidities.

Main outcome measures: Primary endpoint was recurrence-free survival. Secondary endpoints included progression-free survival and overall survival.

Results: Three hundred and nine patients were included in the analysis. There were no significant differences between dexamethasone exposed (n = 107) and non-exposed patients in recurrence-free survival ([5 year estimate (95% CI)] = 71 (62-82) % vs. 71 (64-78) %, p = 1.0), progression-free survival (57 [47-68] % vs. 60 [53-68] %, p = 0.9), or overall survival (68 [59-79] % vs. 71 [64-79] %, p = 1.0). In univariate analysis, significant predictors of recurrence-free survival were tumor stage (p = 0.02), tumor grade (0.003) and receipt of adjuvant chemotherapy (p < 0.001). In the multivariable model, higher tumor grade (hazard ratio [HR] [95% CI] = 2.3 [1.4-3.9], p = 0.002) and receipt of adjuvant chemotherapy (3.2 [1.8-5.8], p < 0.001), but not dexamethasone (0.9 [0.5-1.5], p = 0.7), were significant predictors of recurrence-free survival.

Conclusions: Dexamethasone administration was not associated with an increased risk of recurrence in women having surgery for endometrial cancer. Limitations of the study include its retrospective single center design and the fact that administration of dexamethasone was not randomized.

Keywords: Dexamethasone; Endometrial cancer; Postoperative nausea and vomiting.