Ovarian cancer: perioperative cardioselective beta-blocker use is tied to poor survival

  • Gonzalez R & et al.
  • Gynecol Oncol
  • 25 Mar 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • β-blocker use at the time of cytoreductive surgery is associated with worse OS in patients with advanced ovarian cancer.
  • 90% of patients receiving β-blockers received a cardioselective β-blocker.

Why this matters

  • Most patients received cardioselective β-blockers in the current study, and any survival benefit gained in previous reports might be driven by the actions of noncardioselective β-blockers.

Study design

  • 534 women with stage IIIC and IV epithelial ovarian cancer underwent primary or interval cytoreduction.
  • Funding: None disclosed.

Key results

  • 84.8% of women had serous carcinoma.
  • 105 women reported receiving a β-blocker, of whom 90% received a cardioselective β-blocker.
  • The most common β-blockers were metoprolol (47%) and atenolol (38%).
  • Median OS was significantly lower in β-blocker users vs nonusers (29 vs 35 months; P=.007).
  • Median PFS was similar in the 2 groups (P=.953).
  • β-blocker use was associated with worse OS (adjusted HR, 1.57; P=.006) after adjusting for age, race, age-adjusted Charlson comorbidity index, stage, triage to neoadjuvant chemotherapy, histology, residual disease status, statin use, metformin use, and aspirin use.
  • Risk factors for mortality (HR) included:
    • Nonwhite patients (black/Asian/Hispanic/others) vs white patients: 1.85 (P<.001>
    • Triage to neoadjuvant chemotherapy/interval debulking surgery: 1.74 (P<.001>
    • Suboptimal debulking procedure: 1.76 (P=.006).

 Limitations

  • Retrospective design.