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

Br J Anaesth. 2014 Jul;113 Suppl 1:i82-7. doi: 10.1093/bja/aet464. Epub 2014 Jan 23.


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 (n=720) 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)=0.57 [95% confidence interval (CI): 0.37-0.89], P=0.01} and an improved overall survival (OS) [HR=0.35 (95% CI: 0.17-0.70), P=0.03]. In these patients, an NLR >3.3 (identified by a receiver-operating characteristic curve) was associated with a shorter DFS [HR=1.99 (95% CI: 1.16-3.41), P=0.01] and OS [HR=2.35 (95% CI: 1.02-5.43), P=0.046].

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.

Keywords: conservative breast cancer surgery; neutrophil:lymphocyte ratio; non-steroidal anti-inflammatory drugs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Breast Neoplasms / blood
  • Breast Neoplasms / surgery*
  • Diclofenac / administration & dosage
  • Diclofenac / therapeutic use*
  • Disease-Free Survival
  • Drug Administration Schedule
  • Drug Evaluation / methods
  • Female
  • Humans
  • Intraoperative Care / methods*
  • Kaplan-Meier Estimate
  • Ketorolac / administration & dosage
  • Ketorolac / therapeutic use*
  • Lymphocyte Count
  • Mastectomy, Segmental*
  • Middle Aged
  • Neutrophils / pathology
  • Prognosis
  • Retrospective Studies
  • Treatment Outcome


  • Anti-Inflammatory Agents, Non-Steroidal
  • Diclofenac
  • Ketorolac