Impact of perioperative dexmedetomidine on recurrence and survival outcomes in oral cavity squamous cell carcinoma

Abstract

Objectives: To investigate the association between perioperative dexmedetomidine (DEX) use and oncological outcomes-including locoregional recurrence (LRR) and distant metastasis (DM)-in patients undergoing curative surgery for oral cavity squamous cell carcinoma (OCSCC).

Methods: This retrospective cohort study used data from the Taiwan Cancer Registry Database and included patients with stage I-IVB OCSCC who underwent curative surgery between 2007 and 2019. Patients were categorised by DEX exposure status and matched 1:1 using propensity score matching (PSM) based on key clinical and demographic variables. Cox proportional hazards models and competing risk analyses were used to estimate the association between DEX use and oncological outcomes.

Results: After PSM, 8024 patients (4012 per group) were included. Multivariable Cox regression showed that perioperative DEX use was significantly associated with increased risks of LRR (adjusted HR (aHR) 1.67; 95% CI 1.55 to 1.80; p<0.001) and DM (aHR 1.30; 95% CI 1.19 to 1.42; p<0.001).

Discussion: These findings suggest a potential oncological risk associated with perioperative DEX administration. Possible mechanisms include immune modulation and enhanced metastatic potential, as reported in preclinical studies. Further investigation is needed to clarify causal pathways and identify patient subgroups most affected.

Conclusions: Perioperative DEX use is independently associated with increased risks of LRR and DM in OCSCC patients. These results underscore the importance of cautious perioperative management and the need for prospective validation in randomised clinical trials.

Keywords: Databases, Pharmaceutical; Evidence-Based Medicine.

Figure 1. Kaplan-Meier (KM) plot of cumulative incidence of locoregional recurrence in propensity score-matched oral cavity squamous cell carcinoma surgery patients: comparison of dexmedetomidine use and non-use. ‘Time 0’ refers to recurrence events captured within the first monthly follow-up interval (typically within 1–2 months postoperatively), rather than on the day of surgery. These early events are due to the registry’s monthly data aggregation and not indicative of non-radical surgery. All patients included in this cohort underwent curative-intent resection with pathologically confirmed clear margins and neck dissection in accordance with TCRD inclusion criteria. TCRD, Taiwan Cancer Registry Database.