Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medicine, New York, NY, USA.
Department of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland; European Platform for Research Outcomes After Perioperative Interventions in Surgery for Cancer Research Group, European Society of Anaesthesiology and Intensive Care Onco-Anaesthesiology Research Group, Brussels, Belgium; Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
Br J Anaesth. 2023 Aug;131(2):193-196. doi: 10.1016/j.bja.2023.02.001. Epub 2023 Feb 28.
Cao and colleagues present a follow-up analysis of a previous RCT among >1200 older adults (mean age 72 yr) undergoing cancer surgery, originally designed to evaluate the effect of propofol or sevoflurane general anaesthesia on delirium, here to evaluate the effect of anaesthetic technique on overall survival and recurrence-free survival. Neither anaesthetic technique conferred an advantage on oncological outcomes. We suggest that although it is entirely plausible that the observed results are truly robust neutral findings, the present study could be limited, like most published studies in the field, by its heterogeneity and understandable absence of underlying individual patient-specific tumour genomic data. We argue for a precision oncology approach to onco-anaesthesiology research that recognises that cancer is not one but rather many diseases and that tumour genomics (and multi-omics) is a fundamental determinant relating drugs to longer-term outcomes.
曹和同事对之前一项针对 >1200 名接受癌症手术的老年患者（平均年龄 72 岁）的 RCT 进行了随访分析，该 RCT 最初旨在评估异丙酚或七氟醚全身麻醉对谵妄的影响，而本次分析旨在评估麻醉技术对总生存和无复发生存的影响。两种麻醉技术都没有在肿瘤学结果上带来优势。我们认为，尽管观察到的结果确实是稳健的中性发现是完全合理的，但与该领域的大多数已发表研究一样，本研究可能受到其异质性以及缺乏潜在的个体化患者特异性肿瘤基因组数据的限制。我们主张采用精准肿瘤学方法来研究肿瘤麻醉学，认识到癌症不是一种疾病，而是多种疾病，肿瘤基因组学（和多组学）是将药物与长期结果联系起来的一个基本决定因素。
