Intraoperative use of ketorolac or diclofenac is associated with improved disease-free survival and overall survival in conservative breast cancer surgery

Background. An association between the use of non-steroidal anti-inflammatory drugs (NSAIDs) and better outcome after mastectomy and lung surgery for cancer has been recently suggested. In a retrospective analysis, we investigated the association between intraoperative NSAIDs use in conservative breast cancer surgery and breast cancer disease-free survival (DFS). Similarly, we also evaluated the association between breast cancer DFS and preoperative neutrophil:lymphocyte ratio (NLR).
Methods. A retrospective analysis of a single-centre cohort was performed in breast cancer patients (n¼720) with uni- and multivariate analyses, using a Cox regression model.
Results. In conservative breast cancer surgery, the intraoperative use of NSAIDs
(ketorolac or diclofenac) was associated with an improved DFS {hazard ratio
(HR)¼0.57 [95% confidence interval (CI): 0.37–0.89], P¼0.01} and an improved
overall survival (OS) [HR¼0.35 (95% CI: 0.17–0.70), P¼0.03]. In these patients, an NLR. 3.3 (identified by a receiver-operating characteristic curve) was associated with a shorter DFS [HR¼1.99 (95% CI: 1.16–3.41), P¼0.01] and OS [HR¼2.35 (95% CI: 1.02– 5.43), P¼0.046].
Conclusions. Intraoperative NSAIDs and higher preoperative NLR are associated with improved outcome in conservative breast cancer surgery. Prospective, randomized trials to evaluate if these associations are causal are warranted.