Center for Clinical Research Uppsala University, Västmanland Hospital, Västerås, Sweden; Department of Anesthesia and Intensive Care, Västmanland Hospital, Västerås, Sweden; ESAIC Onco Anaesthesiology Research Group, EuroPeriscope, Brussels, Belgium.
Epistat AB, Uppsala, Sweden.
Anesthesiology. 2024 Jun 1;140(6):1126-1133. doi: 10.1097/ALN.0000000000004969.
Prospective interventional trials and retrospective observational analyses provide conflicting evidence regarding the relationship between propofol versus inhaled volatile general anesthesia and long-term survival after cancer surgery. Specifically, bladder cancer surgery lacks prospective clinical trial evidence.
Data on bladder cancer surgery performed under general anesthesia between 2014 and 2021 from the National Quality Registry for Urinary Tract and Bladder Cancer and the Swedish Perioperative Registry were record-linked. Overall survival was compared between patients receiving propofol or inhaled volatile for anesthesia maintenance. The minimum clinically important difference was defined as a 5-percentage point difference in 5-yr survival.
Of 7,571 subjects, 4,519 (59.7%) received an inhaled volatile anesthetic, and 3,052 (40.3%) received propofol for general anesthesia maintenance. The two groups were quite similar in most respects but differed in American Society of Anesthesiologists Physical Status and tumor stage. Propensity score matching was used to address treatment bias. Survival did not differ during follow-up (median, 45 months [interquartile range, 33 to 62 months]) in the full unmatched cohort nor after 1:1 propensity score matching (3,052 matched pairs). The Kaplan-Meier adjusted 5-yr survival rates in the matched cohort were 898 of 3,052, 67.5% (65.6 to 69.3%) for propofol and 852 of 3,052, 68.5% (66.7 to 70.4%) for inhaled volatile general anesthesia, respectively (hazard ratio, 1.05 [95% CI, 0.96 to 1.15]; P = 0.332). A sensitivity analysis restricted to 1,766 propensity score-matched pairs of patients who received only one general anesthetic during the study period did not demonstrate a difference in survival; Kaplan-Meier adjusted 5-yr survival rates were 521 of 1,766, 67.1% (64.7 to 69.7%) and 482 of 1,766, 68.9% (66.5 to 71.4%) for propofol and inhaled volatile general anesthesia, respectively (hazard ratio, 1.09 [95% CI, 0.97 to 1.23]; P = 0.139).
Among patients undergoing bladder cancer surgery under general anesthesia, there was no statistically significant difference in long-term overall survival associated with the choice of propofol or an inhaled volatile maintenance.
前瞻性干预试验和回顾性观察分析提供了相互矛盾的证据，表明全身麻醉下使用丙泊酚与挥发性吸入麻醉剂与癌症手术后的长期生存之间存在关联。具体来说，膀胱癌手术缺乏前瞻性临床试验证据。
从国家泌尿系统和膀胱癌质量登记处和瑞典围手术期登记处中，对 2014 年至 2021 年间进行全身麻醉下的膀胱癌手术的数据进行了记录链接。比较接受丙泊酚或挥发性吸入麻醉维持的患者的总生存率。最小临床重要差异定义为 5 年生存率差异 5 个百分点。
在 7571 名受试者中，4519 名（59.7%）接受了吸入挥发性麻醉剂，3052 名（40.3%）接受了丙泊酚维持全身麻醉。两组在大多数方面非常相似，但在麻醉医师协会身体状况和肿瘤分期方面存在差异。采用倾向评分匹配来解决治疗偏倚问题。在未匹配的全队列中，随访期间（中位随访时间 45 个月[四分位间距 33 至 62 个月]）和 1:1 倾向评分匹配后（3052 对匹配对），生存情况均无差异。在匹配队列中，Kaplan-Meier 调整后的 5 年生存率分别为 3052 例中的 898 例，丙泊酚组为 67.5%（65.6%至 69.3%），3052 例中的 852 例，吸入挥发性全身麻醉组为 68.5%（66.7%至 70.4%）（风险比，1.05[95%置信区间，0.96 至 1.15]；P=0.332）。一项仅限于在研究期间仅接受一种全身麻醉的 1766 对匹配的倾向评分患者的敏感性分析并未显示生存率存在差异；Kaplan-Meier 调整后的 5 年生存率分别为 1766 例中的 521 例，丙泊酚组为 67.1%（64.7%至 69.7%），1766 例中的 482 例，吸入挥发性全身麻醉组为 68.9%（66.5%至 71.4%）（风险比，1.09[95%置信区间，0.97 至 1.23]；P=0.139）。
在接受全身麻醉下膀胱癌手术的患者中，与选择丙泊酚或吸入挥发性维持麻醉剂相关的长期总生存率无统计学显著差异。
