British journal of anaesthesia · 2025
Impact of intraoperative dexmedetomidine on clear cell renal cell carcinoma progression: a retrospective cohort study.
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Wong Ryan, Patel Raj G, Cortes-Mejia Nicolas, Guerra-Londono Juan J, Huang Huang, Gundre Satvik, Napa Nishanth, Cata Juan P
Аннотация
BACKGROUND: Dexmedetomidine, an α-2 adrenoreceptor agonist, is commonly administered during cancer surgery as an adjuvant sedative because of its general anaesthetic agent-sparing effects. We investigated the association between ADRA2 gene expression and dexmedetomidine on oncological outcomes after surgery for clear cell renal cell carcinoma (RCC).
METHODS: We conducted an in silico analysis using a publicly available database and a retrospective study in patients with clear cell RCC. The associations between ADRA2A expression and recurrence-free survival and overall survival were analysed. The same outcomes were investigated in a cohort of patients who underwent partial or total nephrectomy and received dexmedetomidine or not. A propensity score matching strategy was utilised to account for selection bias, and a multivariable analysis was performed to control for variables implicated in survival.
RESULTS: Expression of the ADRA2A gene at the tumour level was not associated with recurrence-free survival; however, higher levels of expression were significantly associated with shorter overall survival. A total of 1766 patients with clear cell RCC were included in the retrospective study. Dexmedetomidine administration was not associated with higher rates of recurrence or mortality or with a significant impact on recurrence-free survival or overall survival.
CONCLUSIONS: Intraoperative administration of dexmedetomidine was not associated with a significant impact on cancer progression and survival. The role of ADRA2A as a prognosis biomarker for clear cell RCC warrants further study.
METHODS: We conducted an in silico analysis using a publicly available database and a retrospective study in patients with clear cell RCC. The associations between ADRA2A expression and recurrence-free survival and overall survival were analysed. The same outcomes were investigated in a cohort of patients who underwent partial or total nephrectomy and received dexmedetomidine or not. A propensity score matching strategy was utilised to account for selection bias, and a multivariable analysis was performed to control for variables implicated in survival.
RESULTS: Expression of the ADRA2A gene at the tumour level was not associated with recurrence-free survival; however, higher levels of expression were significantly associated with shorter overall survival. A total of 1766 patients with clear cell RCC were included in the retrospective study. Dexmedetomidine administration was not associated with higher rates of recurrence or mortality or with a significant impact on recurrence-free survival or overall survival.
CONCLUSIONS: Intraoperative administration of dexmedetomidine was not associated with a significant impact on cancer progression and survival. The role of ADRA2A as a prognosis biomarker for clear cell RCC warrants further study.