Department of Cancer Biology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
Minerva Anestesiol. 2017 Nov;83(11):1137-1145. doi: 10.23736/S0375-9393.17.11881-X. Epub 2017 May 12.
Regional anesthesia has anti-inflammatory effects. Recent studies suggest that regional anesthesia might improve the survival of patients with cancer. We hypothesized that the use of a scalp block (SB) during craniotomy for glioblastoma (GB) decreases the postoperative systemic and local inflammatory response and extend their survival.
This retrospective study included 119 patients with GB who underwent tumor resection. We divided patients into 2 groups based on the use of SB during surgery. Preoperative and postoperative neutrophil-to-lymphocyte (NLR) ratio and platelet-to-lymphocyte (PLR) ratios were calculated as well as the percentage change in postoperative T2/FLAIR (FLuid-Attenuated Inversion Recovery) volume. Both markers of the inflammatory response were compared between patients with and without an SB. Progression-free survival (PFS) was also compared in both groups of patients. Univariate and multivariate analysis were used to test the association between SB and patients' survival.
On day 3 after surgery, patients who had an SB showed statistically significant lower NLRs and PLRs than those without an SB. There was also a significant larger reduction in postoperative T2/FLAIR signal in patients with SB than in those without SB. The median PFS (progression-free survival) was longer in patients with SB (16.7 months) than those without an SB (6.5 months, P<0.001). The multivariate analysis indicated that the use of SB was an independent factor for longer PFS (hazard ratio: 0.31 95% confidence interval: 0.07-0.21, P<0.001).
This retrospective study supports the hypothesis that in patients with GB undergoing craniotomy, the use of SB is associated with lower levels of systemic and local inflammation, and longer survival.
区域麻醉具有抗炎作用。最近的研究表明，区域麻醉可能会提高癌症患者的生存率。我们假设在胶质母细胞瘤（GB）开颅手术中使用头皮阻滞（SB）会降低术后全身和局部炎症反应，并延长其生存时间。
本回顾性研究纳入了 119 名接受肿瘤切除术的 GB 患者。我们根据手术中是否使用 SB 将患者分为两组。计算了术前和术后中性粒细胞与淋巴细胞（NLR）比值和血小板与淋巴细胞（PLR）比值，以及术后 T2/FLAIR（液体衰减反转恢复）体积的百分比变化。比较了两组患者的炎症反应标志物。还比较了两组患者的无进展生存期（PFS）。使用单变量和多变量分析来检验 SB 与患者生存之间的关系。
术后第 3 天，使用 SB 的患者 NLR 和 PLR 明显低于未使用 SB 的患者。SB 组患者术后 T2/FLAIR 信号的降低幅度也明显大于未使用 SB 的患者。使用 SB 的患者中位 PFS（无进展生存期）长于未使用 SB 的患者（16.7 个月比 6.5 个月，P<0.001）。多变量分析表明，使用 SB 是 PFS 延长的独立因素（危险比：0.31，95%置信区间：0.07-0.21，P<0.001）。
本回顾性研究支持以下假设，即在接受开颅手术的 GB 患者中，使用 SB 与较低的全身和局部炎症水平以及较长的生存时间相关。
