Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore.
Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.
Singapore Med J. 2021 Jan;62(1):20-28. doi: 10.11622/smedj.2019123. Epub 2019 Oct 8.
Children with solid organ tumours often present for curative surgery. Even with the best surgical technique, micrometastases can occur. Preclinical studies support the postulation that neuraxial anaesthesia maintains the body's immune and inflammatory milieu against metastasis. However, human retrospective adult studies showed varying results, and no study has been done in children. We aimed to find out if intraoperative epidural, perioperative opioid and volatile dose are associated with relapse-free survival (RFS) in children with solid organ tumours.
This is a retrospective cohort study of 126 children from a tertiary paediatric unit who were diagnosed with solid organ tumours (neuroblastoma, hepatoblastoma or sarcoma) over a 16-year period. RFS, stratified by tumour subtypes, was estimated using the Kaplan-Meier method. Adjusted hazard ratios (aHRs) were obtained from multivariable Cox regression models after taking potential covariates into account.
Of 126 children with solid organ tumours (51.6% neuroblastoma, 34.9% sarcoma and 13.5% hepatoblastoma), 53.2% received combined general anaesthesia (GA)/epidural. A total of 21 (31.3%) and 20 (33.9%) patients relapsed during the study period in the combined GA/epidural group and the GA alone group, respectively. Patients with sarcoma receiving combined GA/epidural had a clinically meaningful lower risk of relapse compared to patients receiving GA alone (aHR 0.51, 95% confidence interval 0.14-1.79), although this was not statistically significant.
Our study demonstrated some clinically meaningful associations, especially in paediatric sarcoma patients. Overall, however, there was no statistically significant association between epidural use and an improved RFS.
患有实体器官肿瘤的儿童通常需要进行根治性手术。即使采用了最佳的手术技术，微转移仍可能发生。临床前研究支持这样一种假设，即椎管内麻醉可维持机体的免疫和炎症环境，以防止转移。然而，人体回顾性成人研究结果不一，尚无研究在儿童中进行。我们旨在确定儿童实体瘤患者术中硬膜外麻醉、围手术期阿片类药物和挥发性药物剂量是否与无复发生存（RFS）相关。
这是一项回顾性队列研究，纳入了 16 年间在一家三级儿科病房被诊断为实体瘤（神经母细胞瘤、肝母细胞瘤或肉瘤）的 126 名儿童。使用 Kaplan-Meier 方法估计 RFS，并按肿瘤亚型分层。在考虑潜在协变量后，使用多变量 Cox 回归模型获得调整后的风险比（aHR）。
在 126 名患有实体瘤的儿童（51.6%为神经母细胞瘤、34.9%为肉瘤和 13.5%为肝母细胞瘤）中，53.2%接受了全身麻醉（GA）/硬膜外麻醉联合治疗。在联合 GA/硬膜外麻醉组和单独 GA 组中，分别有 21 名（31.3%）和 20 名（33.9%）患者在研究期间复发。与单独接受 GA 的患者相比，接受联合 GA/硬膜外麻醉的肉瘤患者复发风险显著降低（aHR 0.51，95%置信区间 0.14-1.79），尽管这无统计学意义。
我们的研究显示了一些具有临床意义的关联，尤其是在儿科肉瘤患者中。然而，总体而言，硬膜外麻醉的使用与 RFS 的改善之间无统计学显著关联。
