Universität zu Köln

Yap, A., Lopez-Olivo, M. A., Dubowitz, J., Pratt, G., Hiller, J., Gottumukkala, V., Sloan, E., Riedel, B. and Schier, R. (2018). Effect of beta-blockers on cancer recurrence and survival: a meta-analysis of epidemiological and perioperative studies. Br. J. Anaesth., 121 (1). S. 45 - 58. OXFORD: ELSEVIER SCI LTD. ISSN 1471-6771

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Abstract

Background: The biological perturbation associated with psychological and surgical stress is implicated in cancer recurrence. Preclinical evidence suggests that beta-blockers can be protective against cancer progression. We undertook a meta-analysis of epidemiological and perioperative clinical studies to investigate the association between beta-blocker use and cancer recurrence (CR), disease-free survival (DFS), and overall survival (OS). Methods: Databases were searched until September 2017, reported hazard ratios (HRs) pooled, and 95% confidence intervals (CIs) calculated. Comparative studies examining the effect of beta-blockers (selective and non-selective) on cancer outcomes were included. The Newcastle Ottawa Scale was used to assess methodological quality and bias. Results: Of the 27 included studies, nine evaluated the incidental use of non-selective beta-blockers, and ten were perioperative studies. Beta-blocker use had no effect on CR. Within subgroups of cancer, melanoma was associated with improved DFS (HR 0.03, 95% CI 0.01-0.17) and OS (HR 0.04, 95% CI 0.00-0.38), while endometrial cancer had an associated reduction in DFS (HR 1.40, 95% CI 1.10-1.80) and OS (HR 1.50, 95% CI 1.12-2.00). There was also reduced OS seen with head and neck and prostate cancer. Non-selective beta-blocker use was associated with improved DFS and OS in ovarian cancer, improved DFS in melanoma, but reduced OS in lung cancer. Perioperative studies showed similar variable effects across cancer types, albeit from a limited data pool. Conclusion: Beta-blocker use had no evident effect on CR. The beneficial effect of beta-blockers on DFS and OS in the epidemiological or perioperative setting remains variable, tumour-specific, and of low-level evidence at present.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Yap, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lopez-Olivo, M. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Dubowitz, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pratt, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hiller, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gottumukkala, V. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sloan, E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Riedel, B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schier, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-181442
DOI:	10.1016/j.bja.2018.03.024
Journal or Publication Title:	Br. J. Anaesth.
Volume:	121
Number:	1
Page Range:	S. 45 - 58
Date:	2018
Publisher:	ELSEVIER SCI LTD
Place of Publication:	OXFORD
ISSN:	1471-6771
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language IMMORTAL TIME BIAS; BREAST-CANCER; OVARIAN-CANCER; TUMOR PROGRESSION; THERAPY IMPROVE; CHRONIC STRESS; MOUSE MODEL; RISK; SURGERY; IMPACT Multiple languages Anesthesiology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/18144