Lu Yanan, Liu Ting, Wang Peizong, Chen Yi, Ji Fengtao, Hernanz Fernando, Zucca-Matthes Gustavo, Youssif Sherif, Peng Shuling, Xu Dongni
Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Anesthesiology, Sun Yat-sen University Cancer Center, Guangzhou, China.
Ann Transl Med. 2021 Sep;9(18):1467. doi: 10.21037/atm-21-4392.
Breast cancer is currently the leading cause of women's death. It is crucial to further improve the approach to treatment and the long-term survival rate of breast cancer patients, and to reduce the rates of recurrence and metastasis. It has been reported that the possibility of tumor metastasis depends on the metastatic potential of the tumor and the host defense against tumor metastasis, in which cellular immunity and the function of natural killer (NK) cells are critical to maintaining this balance. Surgical stress response and postoperative pain inhibit perioperative immune function in patients and increase the likelihood of dissemination and metastasis of cancer cells after cancer surgery. The study aims to investigate the effect of anesthetic factors and pain treatment on the long-term prognosis of patients with early stage lymph node negative breast preservation surgery.
A total of 337 patients with early-stage lymph node negative breast cancer (ASA I-II) who had undergone successful breast-conserving surgery in our hospital were included in this retrospective analysis. Cases were divided into general anesthesia with postoperative analgesia group (GA + PCA), general anesthesia without postoperative analgesia group (GA), epidural anesthesia with postoperative analgesia group (EA + PCA), and epidural anesthesia without postoperative analgesia group (EA). The 5-year survival rate and 5-year disease-free survival were recorded in the 4 groups.
The general condition and length of hospital stay of the patients were not statistically different between the 4 groups. However, the 5-year survival rate and 5-year disease-free survival rate of the 4 groups were statistically different. The 5-year survival rate and 5-year disease-free survival rate were the lowest in the GA group, while the EA + PCA group had the highest 5-year disease-free survival rate. The 5-year survival rate and 5-year disease-free survival rate in the GA + PCA group were significantly higher than those in the GA group. The 5-year disease-free survival rate in EA group was significantly higher than GA group.
Epidural anesthesia and postoperative pain treatment maybe beneficial to the long-term prognosis of patients with early-stage lymph node-negative breast cancer.
乳腺癌是目前女性死亡的主要原因。进一步改进乳腺癌的治疗方法和提高患者的长期生存率，降低复发和转移率至关重要。据报道，肿瘤转移的可能性取决于肿瘤的转移潜能和宿主对肿瘤转移的防御，其中细胞免疫和自然杀伤（NK）细胞的功能对于维持这种平衡至关重要。手术应激反应和术后疼痛会抑制患者围手术期的免疫功能，并增加癌症手术后癌细胞播散和转移的可能性。本研究旨在探讨麻醉因素和疼痛治疗对早期淋巴结阴性保乳手术患者长期预后的影响。
本回顾性分析纳入了我院337例成功接受保乳手术的早期淋巴结阴性乳腺癌患者（ASA I-II级）。病例分为全麻术后镇痛组（GA + PCA）、全麻无术后镇痛组（GA）、硬膜外麻醉术后镇痛组（EA + PCA）和硬膜外麻醉无术后镇痛组（EA）。记录4组患者的5年生存率和5年无病生存率。
4组患者的一般情况和住院时间差异无统计学意义。然而，4组患者的5年生存率和5年无病生存率差异有统计学意义。GA组的5年生存率和5年无病生存率最低，而EA + PCA组的5年无病生存率最高。GA + PCA组的5年生存率和5年无病生存率显著高于GA组。EA组的5年无病生存率显著高于GA组。
硬膜外麻醉和术后疼痛治疗可能有利于早期淋巴结阴性乳腺癌患者的长期预后。
