University Department of Anaesthesiology and Pain Therapy, University Hospital Bern, and Institute of Mathematical Statistics and Actuarial Science, University of Bern, Berne, Switzerland.
Anesthesiology. 2010 Sep;113(3):570-6. doi: 10.1097/ALN.0b013e3181e4f6ec.
Recently published studies suggest that the anesthetic technique used during oncologic surgery affects cancer recurrence. To evaluate the effect of anesthetic technique on disease progression and long-term survival, we compared patients receiving general anesthesia plus intraoperative and postoperative thoracic epidural analgesia with patients receiving general anesthesia alone undergoing open retropubic radical prostatectomy with extended pelvic lymph node dissection.
Two sequential series were studied. Patients receiving general anesthesia combined with epidural analgesia (January 1994-June 1997, n=103) were retrospectively compared with a group given general anesthesia combined with ketorolac-morphine analgesia (July 1997-December 2000, n=158). Biochemical recurrence-free survival, clinical progression-free survival, cancer-specific survival, and overall survival were assessed using the Kaplan-Meier technique and compared using a multivariate Cox-proportional-hazards regression model and an alternative model with inverse probability weights to adjust for propensity score.
Using propensity score adjustment with inverse probability weights, general anesthesia combined with epidural analgesia resulted in improved clinical progression-free survival (hazard ratio, 0.45; 95% confidence interval, 0.27-0.75, P=0.002). No significant differences in the two groups were found for biochemical recurrence-free survival, cancer-specific survival, or overall survival. Higher preoperative serum values for prostate-specific antigen, specimen Gleason score of at least 7, non-organ-confined tumor stage, and positive lymph node status were independent predictors of biochemical recurrence-free survival.
General anesthesia with epidural analgesia was associated with a reduced risk of clinical cancer progression. However, no significant difference was found between general anesthesia plus postoperative ketorolac-morphine analgesia and general anesthesia plus intraoperative and postoperative thoracic epidural analgesia in biochemical recurrence-free survival, cancer-specific survival, or overall survival.
最近发表的研究表明，肿瘤外科手术中使用的麻醉技术会影响癌症的复发。为了评估麻醉技术对疾病进展和长期生存的影响，我们比较了接受全身麻醉加术中及术后胸段硬膜外镇痛的患者与接受全身麻醉加术后酮咯酸-吗啡镇痛的患者行开放性耻骨后根治性前列腺切除术加扩大盆腔淋巴结清扫术的效果。
我们研究了两个连续的系列。接受全身麻醉加硬膜外镇痛的患者（1994 年 1 月至 1997 年 6 月，n=103）与接受全身麻醉加酮咯酸-吗啡镇痛的患者（1997 年 7 月至 2000 年 12 月，n=158）进行回顾性比较。采用 Kaplan-Meier 技术评估生化无复发生存率、临床无进展生存率、癌症特异性生存率和总生存率，并采用多变量 Cox 比例风险回归模型和替代模型（采用逆概率权重进行倾向评分调整）进行比较。
采用逆概率权重进行倾向评分调整后，全身麻醉加硬膜外镇痛可改善临床无进展生存率（风险比，0.45；95%置信区间，0.27-0.75，P=0.002）。两组在生化无复发生存率、癌症特异性生存率或总生存率方面均无显著差异。术前前列腺特异性抗原值较高、标本 Gleason 评分≥7、非器官局限肿瘤分期和阳性淋巴结状态是生化无复发生存率的独立预测因素。
全身麻醉加硬膜外镇痛与降低临床癌症进展风险相关。然而，全身麻醉加术后酮咯酸-吗啡镇痛与全身麻醉加术中及术后胸段硬膜外镇痛在生化无复发生存率、癌症特异性生存率或总生存率方面无显著差异。
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