局部和区域麻醉是否能提高乳腺癌的治愈率？
Are Cure Rates for Breast Cancer Improved by Local and Regional Anesthesia?
作者信息
Tsigonis Abraham M, Al-Hamadani Mohammed, Linebarger Jared H, Vang Choua A, Krause Forrest J, Johnson Jeanne M, Marchese Edward, Marcou Kristen A, Hudak Jane M, Landercasper Jeffrey
机构信息
From the Departments of *Surgery, †Medical Education, ‡Medical Research, Gundersen Medical Foundation; §Norma J. Vinger Center for Breast Care, Gundersen Health System; and Departments of ∥Anesthesiology and **Clinical Data Services, Gundersen Health System, La Crosse, WI.
出版信息
Reg Anesth Pain Med. 2016 May-Jun;41(3):339-47. doi: 10.1097/AAP.0000000000000379.
BACKGROUND AND OBJECTIVES
Recent preclinical basic science studies suggest that patient tumor immunity is altered by general anesthesia (GA), potentially worsening cancer outcomes. A single retrospective review concluded that breast cancer patients receiving paravertebral block and GA had better cancer outcomes compared with patients receiving GA alone. This study has not been validated. We hypothesized that local or regional anesthesia (LRA) would be associated with better cancer outcomes compared with GA.
METHODS
We retrospectively reviewed a prospectively collected database to identify all stage 0-III breast cancer patients undergoing surgery in a single center during a 9-year period ending January 1, 2010. Patients were divided into 2 groups: those who received only LRA and those who received GA. Overall survival (OS), disease-free survival (DFS), and local regional recurrence (LRR) were calculated using the Kaplan-Meier method with log-rank comparison before and after propensity score matching.
RESULTS
Median age of the 1107 patients who met study criteria was 64 years (range, 24-97 years). Median and longest follow-up were 5.5 and 12.5 years, respectively. General anesthesia was used for 461 patients (42%), and 646 (58%) received LRA. The point estimates of cumulative OS, DFS, and LRR "free" rates at 5 years for the GA and LRA groups were 85.5% and 87.1%, 94.2% and 96.1%, and 96.3% and 95.8%, respectively. Cox regression showed no significant differences between the 2 groups (GA and LRA) for the 3 outcomes: OS (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.59-1.10; P = 0.17), DFS (HR, 0.91; 95% CI, 0.55-1.76; P = 0.87), and LRR (HR, 1.73; 95% CI, 0.83-3.63; P = 0.15).
CONCLUSIONS
Breast cancer OS, DFS, and LRR were not affected by type of anesthesia in our institution. This result differs from that of the only prior published clinical report on this topic and does not provide clinical corroboration of the basic science studies that suggest oncologic benefits to LRA.
背景与目的
近期临床前基础科学研究表明，全身麻醉（GA）会改变患者的肿瘤免疫，可能使癌症预后恶化。一项回顾性研究得出结论，与仅接受全身麻醉的患者相比，接受椎旁阻滞和全身麻醉的乳腺癌患者有更好的癌症预后。但该研究尚未得到验证。我们假设与全身麻醉相比，局部或区域麻醉（LRA）与更好的癌症预后相关。
方法
我们回顾性分析了一个前瞻性收集的数据库，以确定在截至2010年1月1日的9年期间，在单一中心接受手术的所有0-III期乳腺癌患者。患者分为两组：仅接受局部或区域麻醉的患者和接受全身麻醉的患者。采用Kaplan-Meier法计算总生存期（OS）、无病生存期（DFS）和局部区域复发（LRR），并在倾向评分匹配前后进行对数秩检验比较。
结果
符合研究标准的1107例患者的中位年龄为64岁（范围24-97岁）。中位随访时间和最长随访时间分别为5.5年和12.5年。461例患者（42%）使用了全身麻醉，646例（58%）接受了局部或区域麻醉。全身麻醉组和局部或区域麻醉组5年累积总生存期、无病生存期和局部区域复发“无”率的点估计分别为85.5%和87.1%、94.2%和96.1%、96.3%和95.8%。Cox回归显示，两组（全身麻醉组和局部或区域麻醉组）在三个结局方面无显著差异：总生存期（风险比[HR]，0.81；95%置信区间[CI]，0.59-1.10；P = 0.17）、无病生存期（HR，0.91；95%CI，0.55-1.76；P = 0.87）和局部区域复发（HR，1.73；95%CI，0.83-3.63；P = 0.15）。
结论
在我们机构，乳腺癌的总生存期、无病生存期和局部区域复发不受麻醉类型的影响。这一结果与之前关于该主题唯一发表的临床报告不同，也未为表明局部或区域麻醉对肿瘤有益的基础科学研究提供临床佐证。
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