Li Ru, Liu Hengrui, Dilger James P, Lin Jun
Department of Anesthesiology, Stony Brook University Health Sciences Center, Stony Brook, NY, 11794-8480, USA.
BMC Anesthesiol. 2018 Jun 26;18(1):77. doi: 10.1186/s12871-018-0543-3.
Breast cancer is the second leading cause of cancer death in women. Surgery is the first line of treatment for breast cancer. Retrospective clinical studies suggest that the type of anesthesia administered during oncological surgery may influence patient outcome. Propofol, the widely used intravenous anesthetic agent, may lead to better outcomes compared to volatile anesthetics. Here we review the literature on the effect of propofol in breast cancer cells, the immune system, pain management, and patient outcomes. Evidence from the study of breast cancer cell lines suggests that high concentrations of propofol have both anti-tumor and pro-tumor effects. Propofol and volatile anesthetics have different effects on the immune system. Propofol has also been shown to reduce the development and severity of acute and chronic pain following surgery. Although a retrospective study that included many types of cancer indicated that propofol increases the long-term survival of patients following surgery, the evidence for this in breast cancer is weak. It has been shown that Propofol combined with paravertebral block led to change of serum composition that affects the breast cancer cell behaviors and natural killer cell activity. Prospective studies are in progress and will be finished within 5 years. The existing evidence is not sufficient to warrant changes to current anesthetic management. Further research is needed to clarify the mechanisms by which propofol affects cancer cells and the immune system.
乳腺癌是女性癌症死亡的第二大主要原因。手术是乳腺癌的一线治疗方法。回顾性临床研究表明，肿瘤手术期间使用的麻醉类型可能会影响患者的预后。与挥发性麻醉剂相比，广泛使用的静脉麻醉剂丙泊酚可能会带来更好的预后。在此，我们综述了关于丙泊酚对乳腺癌细胞、免疫系统、疼痛管理及患者预后影响的文献。对乳腺癌细胞系的研究证据表明，高浓度丙泊酚具有抗肿瘤和促肿瘤双重作用。丙泊酚和挥发性麻醉剂对免疫系统有不同影响。丙泊酚还被证明可减轻术后急性和慢性疼痛的发生及严重程度。尽管一项纳入多种癌症类型的回顾性研究表明丙泊酚可提高患者术后的长期生存率，但在乳腺癌方面的证据尚不充分。研究表明，丙泊酚联合椎旁阻滞会导致血清成分改变，进而影响乳腺癌细胞行为和自然杀伤细胞活性。前瞻性研究正在进行中，将在5年内完成。现有证据不足以支持改变当前的麻醉管理方式。需要进一步研究以阐明丙泊酚影响癌细胞和免疫系统的机制。
