Watanabe Katsuya, Masuda Haruhiko, Noma Daisuke
National Hospital Organization Yokohama Medical Center, Yokohama, Japan.
Department of Surgery, Yokohama City University, Yokohama, Japan.
Front Surg. 2022 Jul 26;9:886241. doi: 10.3389/fsurg.2022.886241. eCollection 2022.
It has been widely recognized that both surgery and anesthesia may increase the risk of cancer recurrence by inducing an inflammatory response and immunosuppression in various cancer operations. The present study explored using hazard curves how anesthetic and analgesic techniques regarding the host inflammation status affect the risk of recurrence over time in patients with non-small-cell lung cancer (NSCLC).
Clinicopathological data from patients who underwent complete pulmonary resection with pathological I-IIIB stage NSCLC from 2010 to 2020 were collected. The inflammation-based scores, including the C-reactive protein-to-albumin ratio (CAR), systemic immune-inflammation index (SII), Glasgow prognostic score (GPS), and modified GPS (mGPS), were calculated before surgery, and hazard curves indicating the changes in hazards over time were evaluated.
A total of 396 patients were eligible for the analysis. The median follow-up was 42.3 months. In total, 118 patients (29.8%) experienced recurrence, and 66.9% of those occurred within 24 months after surgery. According to the multivariate Cox regression analysis, volatile anesthesia (VA) (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.05-2.71), and elevated CAR (HR, 1.88; 95% CI, 1.18-2.99) were associated with a worse recurrence-free survival. The resulting hazard curve revealed that a delayed peak of recurrence was present in patients with a low CAR in the VA group and in those with intravenous flurbiprofen axetil administration in the propofol-based total intravenous anesthesia group (30 and 24 months after surgery, respectively).
Choosing anesthetic and analgesic techniques while taking inflammation-based scores into account may be useful for reducing the risk of and/or delaying recurrence in patients undergoing resection for NSCLC.
人们普遍认识到，手术和麻醉都可能通过在各种癌症手术中引发炎症反应和免疫抑制来增加癌症复发的风险。本研究使用风险曲线探讨了与宿主炎症状态相关的麻醉和镇痛技术如何随时间影响非小细胞肺癌（NSCLC）患者的复发风险。
收集了2010年至2020年接受病理I-IIIB期NSCLC完全肺切除术患者的临床病理数据。在手术前计算基于炎症的评分，包括C反应蛋白与白蛋白比值（CAR）、全身免疫炎症指数（SII）、格拉斯哥预后评分（GPS）和改良GPS（mGPS），并评估显示风险随时间变化的风险曲线。
共有396例患者符合分析条件。中位随访时间为42.3个月。总共有118例患者（29.8%）出现复发，其中66.9%发生在术后24个月内。根据多变量Cox回归分析，挥发性麻醉（VA）（风险比[HR]，1.69；95%置信区间[CI]，1.05-2.71）和CAR升高（HR，1.88；95%CI，1.18-2.99）与无复发生存期较差相关。所得风险曲线显示，VA组中CAR较低的患者以及丙泊酚全静脉麻醉组中静脉注射氟比洛芬酯的患者出现复发的峰值延迟（分别在术后30个月和24个月）。
在考虑基于炎症的评分的同时选择麻醉和镇痛技术可能有助于降低NSCLC切除术患者的复发风险和/或延迟复发。
