■阿片类药物使用障碍是一种不断演变的危机,17.2%的术后患者在手术后一年继续服用阿片类药物处方。临床前研究表明围手术期使用阿片类药物,这里定义为用于手术疼痛的阿片类药物,可能与较差的肿瘤预后有关。如果这是真的,手术患者的阿片类药物最小化策略可能以多种方式减少阿片类药物相关死亡。本文旨在描述围手术期阿片类药物使用与乳腺癌复发之间的关系。
■2021年11月1日,我们在Ovid和EMBASE数据库中搜索了术语“乳腺肿瘤”,“阿片类镇痛药”,“肿瘤复发”,和“肿瘤转移”。在检索到的350篇文章中,11符合我们的纳入标准。审查是通过提高报告质量综合研究(ENTREQ)清单的透明度来进行的。
■临床研究报告围手术期使用阿片类药物与局部或远处乳腺癌复发之间没有明确关联。在评估围手术期阿片类药物的使用和总体生存率时,发现混合结果。多项研究自相矛盾地发现,阿片类药物的使用与较低的复发率有关。尽管死亡率较高。大多数研究表明,接受或未接受含阿片类药物镇痛的乳腺癌手术患者的复发或生存率没有差异,尽管大多数研究结果受到研究设计和乳腺癌患者事件发生率低的限制.
■围手术期使用阿片类药物与乳腺癌复发之间缺乏明确的联系,这与一些临床前数据相矛盾,其中描述了阿片类药物上调肿瘤增殖的机制,这可能使肿瘤学结果恶化。现有的临床文献仅限于主要是早期乳腺癌患者的回顾性研究。事件发生率低。鉴于日益恶化的阿片类药物流行和临床前研究结果,阿片类药物最小化策略仍需探索。未来的工作应该是前瞻性的,并检查具有更晚期肿瘤病理的高风险患者的癌症复发。
UNASSIGNED: Opioid use disorder is an evolving crisis, and 17.2% of postsurgical patients continue to fill an opioid prescription one year after surgery. Preclinical studies suggest perioperative opioid use, defined here as opioids used in the setting of operative pain, may be linked to inferior oncologic outcomes. If this were true, opioid minimization strategies for surgical patients may reduce opioid-related deaths in more than one way. This
review aims to describe the association between perioperative opioid use and breast cancer recurrence.
UNASSIGNED: On November 1, 2021, we searched the Ovid and EMBASE databases for the terms \"breast neoplasm\", \"opioid analgesics\", \"neoplasm recurrence\", and \"neoplasm metastasis\". Of the 350 articles retrieved, 11 met our inclusion criteria. The
review was undertaken using the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) checklist for quality.
UNASSIGNED: Clinical studies report no clear association between perioperative opioid use and local or distant breast cancer recurrence. Mixed results were found when assessing perioperative opioid use and overall survival. Multiple studies paradoxically found opioid use to be associated with lower recurrence rates, despite higher mortality rates. Most studies showed no difference in recurrence or survival in breast cancer surgery patients who did or did not receive opioid-containing analgesia, although most findings were limited by study design and low event rates in patients with breast cancer.
UNASSIGNED: The lack of a clear connection between perioperative opioid use and breast cancer recurrence contradicts some preclinical data, which describes mechanisms through which opioids upregulate tumor proliferation which might worsen oncologic outcomes. Existing clinical literature is limited to mostly retrospective studies in patients with predominantly early-stage breast cancers, with low event rates. Given the worsening opioid epidemic and preclinical study findings, opioid minimization strategies should still be explored. Future work should be prospective and examine cancer recurrence in high-risk patients with more advanced tumor pathologies.