Department of Breast Surgery, Hiroshima Mark Clinic, Hiroshima, Japan.
Department of Breast Surgery, Hiroshima City Hospital, Hiroshima, Japan.
Cancer Rep (Hoboken). 2023 Jan;6(1):e1643. doi: 10.1002/cnr2.1643. Epub 2022 Jun 2.
Recurrence after primary treatment is an important obstacle to the curing of primary breast cancer. Less-immunosuppressive anesthetic techniques, such as local anesthesia with lidocaine, intravenous anesthesia (IVA) with propofol, and/or sedation with midazolam under spontaneous breathing may reduce breast cancer recurrence compared with standard general anesthesia techniques such as IVA and inhalation anesthesia with opioids under mechanical ventilation.
The aim of this study was to analyze the factors involved in breast cancer recurrence in patients who underwent breast-conserving surgery (BCS) under non-mechanically ventilated anesthesia.
The study included 491 consecutive patients with stages 0-III breast cancer who underwent BCS/axillary lymph-node management with local anesthesia and IVA and/or sedation under non-mechanical ventilation between May 2008 and September 2021. Survival and recurrence were assessed by retrospective cohort analysis.
The median follow-up period was 2565 days (range, 28-4834 days). The overall and breast cancer-specific survival rates were 92.9% and 95.6%, respectively. Twenty-one deaths, of which 11 were breast cancer-related, occurred. Disease recurred in 29 (5.9%) patients, of whom 15 patients received neoadjuvant chemotherapy (NAC) and 14 patients received adjuvant therapy (chemotherapy in 12 cases). The surgical procedure performed, but not other clinicopathological factors [recurrence site, P stage, tumor subtype, and disease-free interval (DFI)], differed between the NAC and adjuvant therapy groups. The DFI tended to be shorter in the NAC group than in the adjuvant therapy group. The pathological therapeutic effect grade after NAC was 1 in 12 patients and ≥2 in 3 patients.
More than 50% (15/29) of patients with recurrence who underwent BCS were given NAC, but most patients did not respond to it. Similarly, adjuvant chemotherapy may not have contributed to the eradication of residual tumor cells after BCS. To reduce breast cancer recurrence in patients undergoing BCS, treatment strategies, especially for patients who do not respond to NAC or adjuvant chemotherapy, need to be developed. Non-mechanical ventilation anesthesia may also affect the incidence of breast cancer recurrence.
原发性乳腺癌治疗后复发是治愈的重要障碍。与标准全身麻醉技术（如机械通气下的 IVA 和吸入麻醉与阿片类药物）相比，使用利多卡因局部麻醉、异丙酚静脉麻醉（IVA）和/或咪达唑仑镇静下自主呼吸等免疫抑制作用较小的麻醉技术可能会降低乳腺癌复发的风险。
本研究旨在分析在非机械通气麻醉下接受保乳手术（BCS）的患者中乳腺癌复发的相关因素。
本研究纳入了 2008 年 5 月至 2021 年 9 月期间接受局部麻醉和 IVA 和/或非机械通气镇静下 BCS/腋窝淋巴结管理的 491 例 0-III 期乳腺癌连续患者。通过回顾性队列分析评估生存和复发情况。
中位随访时间为 2565 天（范围 28-4834 天）。总生存率和乳腺癌特异性生存率分别为 92.9%和 95.6%。21 例死亡，其中 11 例与乳腺癌相关。29 例患者发生疾病复发，其中 15 例患者接受了新辅助化疗（NAC），14 例患者接受了辅助治疗（12 例化疗）。NAC 组和辅助治疗组的手术方式不同，但其他临床病理因素（复发部位、P 分期、肿瘤亚型和无病间期（DFI））无差异。NAC 组的 DFI 倾向于短于辅助治疗组。NAC 后病理治疗效果分级为 1 级 12 例，≥2 级 3 例。
超过 50%（15/29）接受 BCS 治疗的复发患者接受了 NAC，但大多数患者对此无反应。同样，辅助化疗可能并未有助于消除 BCS 后残留的肿瘤细胞。为了降低接受 BCS 治疗的患者乳腺癌复发的风险，需要制定治疗策略，特别是针对对 NAC 或辅助化疗无反应的患者。非机械通气麻醉也可能影响乳腺癌复发的发生率。
