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Meta-Analysis
. 2021 Nov 8;23(12):146.
doi: 10.1007/s11912-021-01133-8.

Perioperative NSAIDs and Long-Term Outcomes After cancer Surgery: a Systematic Review and Meta-analysis

Shebin Shaji #  1 , Charlotte Smith #  2 , Patrice Forget  3   4
Affiliations
Meta-Analysis

Perioperative NSAIDs and Long-Term Outcomes After cancer Surgery: a Systematic Review and Meta-analysis

Shebin Shaji et al. Curr Oncol Rep. .

Abstract

Purpose of review: This review investigated the use of perioperative non-steroidal anti-inflammatory drugs (NSAIDs) and long-term outcomes in cancer surgery patients, and whether this is dependent on cancer type, type of NSAID and timing of administration.

Findings: Perioperative NSAID use was found to be associated with longer disease-free survival (hazard ration, HR = 0.84 (95% CI, 0.73-0.97)) and overall survival (HR = 0.78 (95% CI, 0.64-0.94)). No difference was found between different types of NSAID for disease-free survival, although in overall survival ketorolac use was significant (HR = 0.63 (95% CI, 0.42-0.95)). Analysis on the timing of NSAID administration found no subgroup to be associated with cancer outcomes. The cancer-type analysis found an association with outcomes in breast and ovarian cancers. However, the level of certainty remains very low, mostly due to the heterogeneity and the retrospective nature of most studies. Perioperative NSAID use may be associated with increased disease-free and overall survival after cancer surgery. This may be dependent on the type of cancer and type of NSAID, and further research is needed to support this. These data may inform future prospective trials, which are needed to determine the clinical impact, as well as optimal NSAID regimen.

Keywords: Cancer; Disease-free survival; Long-term outcomes; NSAIDs; Perioperative; Surgery.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram illustrating the number of studies included in each stage of the literature search. Adapted from PRISMA guidelines [26]
Fig. 2
Fig. 2
Search Strategy Example - Cochrane Database, searched 14/01/2021
Fig. 3
Fig. 3
Comparison of disease-free survival in any perioperative NSAID use vs. no perioperative NSAID use. Studies included are those that provided hazard ratios for disease-free survival, with 95% confidence intervals. Desmedt 2018a = ketorolac; Desmedt 2018b = diclofenac; Forget 2010a = diclofenac; Forget 2010b = ketorolac; Forget 2013a = breast centre 1; Forget 2013b = breast centre 2; Forget 2013d =lung centre.
Fig. 4
Fig. 4
Comparison of overall survival in perioperative NSAID use vs. no perioperative NSAID use. Studies included are those that provided hazard ratios for overall survival, with 95% confidence intervals. Forget 2013a = breast centre 1; Forget 2013b = breast centre 2; Forget 2013d =lung centre
Fig. 5
Fig. 5
shows DFS stratified by type of cancer. Desmedt 2018a = ketorolac; Desmedt 2018b = diclofenac; Forget 2010a = diclofenac; Forget 2010b = ketorolac; Forget 2013a = breast centre 1; Forget 2013b = breast centre 2; Forget 2013d = lung centre; Schack 2019a = diclofenac; Schack 2019b = ibuprofen; Schack 2019c = overall NSAID group.
Fig. 6
Fig. 6
shows OS stratified by type of cancer. Desmedt 2018a = ketorolac; Forget 2013a = breast centre 1; Forget 2013b = breast centre 2; Forget 2013d = lung centre; Schack 2019c = overall NSAID group.
Fig. 7
Fig. 7
Comparison of disease-free survival in perioperative NSAID use vs. no perioperative NSAID use, grouped by type of NSAID given. Studies included are those that provided hazard ratios for disease-free survival, with 95% confidence intervals, in a specific named NSAID drug. Desmedt 2018a = ketorolac; Desmedt 2018b = diclofenac; Forget 2010a = diclofenac; Forget 2010b = ketorolac; Forget 2013b = breast centre 2; Forget 2013d = lung centre; Schack 2019a = diclofenac; Schack 2019b = ibuprofen
Fig. 8
Fig. 8
Comparison of overall survival in perioperative NSAID use vs. no perioperative NSAID use, stratified by type of NSAID. Studies included are those that provided hazard ratios for overall survival, with 95% confidence intervals, in a specific named NSAID type. Forget 2013b = breast centre 2; Forget 2013d = lung centre; Schack 2019a = diclofenac; Schack 2019b = ibuprofen
Fig. 9
Fig. 9
Comparison of disease-free survival in NSAID use vs. no NSAID use, grouped by the timing of NSAID administration. Studies are grouped to compare intraoperative, postoperative, and preoperative use. Studies included are those that provided hazard ratios for disease-free survival, with 95% confidence intervals, and gave NSAIDs at specific time points only, or investigated specific time point subgroups. Desmedt 2018a = ketorolac; Desmedt 2018b = diclofenac; Forget 2010a = diclofenac; Forget 2010b = ketorolac; Forget 2013d = lung centre; Schack 2019a = diclofenac; Schack 2019b = ibuprofen
Fig. 10
Fig. 10
Comparison of overall survival in NSAID use vs. no NSAID use, grouped by the timing of NSAID administration. Studies are grouped to compare intraoperative use with postoperative use. Studies included are those that provided hazard ratios for overall survival, with 95% confidence intervals, and gave NSAIDs at specific time points only, or investigated specific time point subgroups. Forget 2013d = lung centre; Schack 2019a = diclofenac; Schack 2019b = ibuprofen.
See this image and copyright information in PMC

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