Background/Objectives: Lidocaine has demonstrated immunomodulatory properties and promising antitumor effects in experimental models, but its impact on long-term outcomes following oncologic surgery remains unclear. This study aimed to compare the impact of intraoperative lidocaine versus remifentanil on long-term cancer outcomes after primary lung cancer surgery.Methods: This is a post hoc analysis of a randomized controlled trial (NCT03905837, EudraCT 2016-004271-52). From 154 patients who underwent elective lung resection via video-assisted thoracoscopic surgery (VATS) between January 2019 and June 2021 and were randomized to receive intraoperative lidocaine (intravenous or paravertebral) or remifentanil, we analyzed data from patients with confirmed primary lung cancer in the surgery specimen. Overall survival (OS) and disease-free survival (DFS) were assessed through May 2025. Survival outcomes were analyzed using Kaplan–Meier curves and log-rank tests. A multivariate Cox proportional hazards model was used to adjust for potential confounders.Results: Among the 97 patients with primary lung cancer finally included in the analysis, those in the lidocaine group exhibited improved OS compared with those who received intravenous remifentanil (log-rankp= 0.022). This association remained significant in the multivariate Cox regression analysis (HR 2.59, 95% CI 1.13–5.96,p= 0.025). No significant differences were observed in DFS overall (log-rankp= 0.283) or in DFS limited to recurrences of cancers present at the time of surgery, either the resected primary tumor or a prior malignancy (log-rankp= 0.080).Conclusions: In this post hoc analysis, lidocaine administration during oncologic lung resection was associated with improved OS in primary lung cancer patients. No differences in DFS were observed between groups; however, a non-significant trend toward improved DFS in lidocaine patients was noted when focusing on recurrences of cancers present at the time of surgery. Further investigation in larger prospective studies is warranted.
背景/目的：利多卡因在实验模型中已显示出免疫调节特性和良好的抗肿瘤效果，但其对肿瘤手术后长期结局的影响尚不明确。本研究旨在比较术中应用利多卡因与瑞芬太尼对原发性肺癌术后长期肿瘤结局的影响。 方法：本研究为一项随机对照试验（NCT03905837，EudraCT 2016-004271-52）的事后分析。在2019年1月至2021年6月期间接受电视辅助胸腔镜手术（VATS）择期肺切除术的154例患者中，随机分配接受术中利多卡因（静脉或椎旁）或瑞芬太尼治疗。我们分析了手术标本确诊为原发性肺癌的患者数据。总生存期（OS）和无病生存期（DFS）评估截至2025年5月。使用Kaplan-Meier曲线和对数秩检验分析生存结局，并采用多变量Cox比例风险模型调整潜在混杂因素。 结果：在最终纳入分析的97例原发性肺癌患者中，与接受静脉瑞芬太尼的患者相比，利多卡因组患者的总生存期有所改善（对数秩检验p=0.022）。多变量Cox回归分析中该关联仍保持显著（HR 2.59，95% CI 1.13–5.96，p=0.025）。在总体无病生存期（对数秩检验p=0.283）或仅限于手术时已存在癌症（包括切除的原发肿瘤或既往恶性肿瘤）复发的无病生存期方面（对数秩检验p=0.080），均未观察到显著差异。 结论：在此事后分析中，肿瘤性肺切除术中应用利多卡因与原发性肺癌患者总生存期的改善相关。组间无病生存期未观察到差异；然而，当聚焦于手术时已存在癌症的复发情况时，利多卡因组患者显示出无病生存期改善的非显著趋势。需要在更大规模的前瞻性研究中进一步验证。
肿瘤(癌症)患者之家