目的 系统性回顾区域麻醉(regional anesthesia,RA)对肿瘤患者术后远期生存率的影响。方法 检索并筛选Pubmed、Cochrane图书馆和Embase数据库中从建库至2020-09-04关于RA与肿瘤远期预后的随机对照试验(randomized controlled trial,RCT)。通过提取时间-事件数据[风险比(hazard ratio,HR)]计算无复发生存期(relapse free survival,RFS)和总生存期(overall survival,OS)的合并效应量。结果 本研究纳入8个RCT共3337例患者。与全身麻醉(general anesthesia,GA)相比,RA对RFS(HR,-0.07;95%CI,-0.22~0.08)、OS(HR,0.05;95%CI,-0.2~0.11)、肿瘤进展时间(time to tumor progress,TTP)(HR,0.03;95%CI,-0.36~0.41)、5年RFS[相对危险度(relative risk,RR),1.26;95%CI,0.66~2.4]和5年OS(RR,1.19;95%CI,0.73~1.96)无影响。基于研究设计、患者特征和肿瘤类型的亚组分析也表明RA对RFS和OS没有影响。结论 没有明显的证据支持RA能够改善肿瘤患者术后的远期生存。
Abstract
Objective To study the effect of regional anesthesia (RA) on long-term survival of cancer patients. Methods Pubmed, Cochrane Library and Embase were searched for randomized controlled trails (RCTs) published from inception to September 4, 2020, in which RA was initiated perioperatively. The time-to-event data (hazard ratio (HR)) was retrieved independently and in duplicate. Pooled estimates of recurrence-free survival (RFS) and overall survival (OS) were calculated. Results Eight RCTs involving 3337 participants were included. Compared with general anesthesia (GA), RA had no effect on RFS (-0.07, 95% CI,-0.22 to 0.08) (GRADE A), OS (0.05, 95% CI, -0.2 to 0.11) (GRADE A), time to tumor progression (0.03, 95% CI, -0.36 to 0.41) (GRADE C) , five-year RFS (risk ratio (RR), 1.26, 95% CI, 0.66 to 2.4) (GRADE C) or 5-year OS (RR, 1.19, 95% CI, 0.73 to 1.96) (GRADE C). Subgroup analysis based on study design, patient characteristics and tumor types also showed no effect of RA on RFS or OS. Conclusions There is no significant evidence supporting the role of RA in improving long-term survival after oncology surgery.
关键词
区域麻醉 /
全身麻醉 /
肿瘤 /
复发 /
生存
Key words
regional anesthesia /
general anesthesia /
tumor /
recurrence /
survival
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参考文献
[1] Ben E S. The promotion of tumor metastasis by surgery and stress: immunological basis and implications for psychoneuroimmunology [J]. Brain Behav Immun,2003,17(1):27-36.
[2] Braun S, Naume B. Circulating and disseminated tumor cells [J]. J Clin Oncol, 2005,23(8):1623.
[3] 张朝旭, 赵 戈, 陈 强. 七氟烷与异氟烷麻醉对老年肺肿瘤术后患者早期认知功能影响的比较 [J]. 武警医学, 2013, 24(6): 498-501.
[4] Brand J M, Kirchner H, Poppe C, et al. The effects of general anesthesia on human peripheral immune cell distribution and cytokine production [J]. Clin Immunol Immunopathol, 1997,83(2):190-194.
[5] Baryosef S, Melamed R, Page G G,et al. Attenuation of the tumor-promoting effect of surgery by spinal blockade in rats [J]. Anesthesiology, 2001,94(6):1066-1073.
[6] Tsui BC, Rashiq S, Schopflocher D, et al. Epidural anesthesia and cancer recurrence rates after radical prostatectomy [J]. Can J Anaesth,2010,57(2):107-112.
[7] Finn D M, Ilfeld B M, Unkart JT ,et al. Post-mastectomy cancer recurrence with and without a continuous paravertebral block in the immediate postoperative period: a prospective multi-year follow-up pilot study of a randomized, triple-masked, placebo-controlled investigation [J]. J Anesth, 2017,31(3):374-379.
[8] Zhu J, Zhang X R, Yang H. Effects of combined epidural and general anesthesia on intraoperative hemodynamic responses, postoperative cellular immunity, and prognosis in patients with gallbladder cancer: a randomized controlled trial [J]. Medicine, 2017,96(10):e6137.
[9] Binczak M, Tournay E, Billard V, et al. Major abdominal surgery for cancer: does epidural analgesia have a long-term effect on recurrence-free and overall survival? [J]. Ann Fr Anesth, 2013,32(5):e81-88.
[10] Karmakar M K, Samy W, Lee A, et al. Survival analysis of patients with breast cancer undergoing a modified radical mastectomy with or without a thoracic paravertebral block: a 5-year follow-up of a randomized controlled trial [J]. Anticancer Res, 2017,37(10):5813-5820.
[11] Christopherson R, James K E, Tableman M, et al. Long-term survival after colon cancer surgery: a variation associated with choice of anesthesia [J]. Anesth Analg,2008,107(1):325-332.
[12] Myles P S, Peyton P, Silbert B, et al. Perioperative epidural analgesia for major abdominal surgery for cancer and recurrence-free survival: randomised trial [J]. BMJ,2011,342(7800):746.
[13] Sessler D I, Pei L, Huang Y, et al. Recurrence of breast cancer after regional or general anaesthesia: a randomised controlled trial [J]. Lancet, 2019,394(10211):1807-1815.
[14] Bunge M B. Apoptosis and caspases in neurodegenerative diseases [J]. New Engl J Med,2003,348(14):1365-1375.
[15] Heaney Á, Buggy D J. Can anaesthetic and analgesic techniques affect cancer recurrence or metastasis? [J]. BJA,2012,109(suppl 1):17.
[16] Wu J, Lanier L L. Natural killer cells and cancer[J]. Cancer,2015,77(7):1226-1243.
[17] Hiller J G, Hacking M B, Link E K, et al. Perioperative epidural analgesia reduces cancer recurrence after gastro-oesophageal surgery [J]. Acta Anaesth Scand,2014,58(3):281-290.
[18] Biki B, Mascha E, Moriarty D C, et al. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis [J]. Anesthesiology,2008,109(2):180-187.
[19] Merquiol F, Montelimard A S, Nourissat A, et al. Cervical epidural anesthesia is associated with increased cancer-free survival in laryngeal and hypopharyngeal cancer surgery: a retrospective propensity-matched analysis [J]. Reg Anesth Pain Med,2013,38(5):398-402.
[20] Wang Y, Wang L, Chen H, et al. The effects of intra- and post-operative anaesthesia and analgesia choice on outcome after gastric cancer resection: a retrospective study[J]. Oncotarget, 2017,8(37):62658-62665.
[21] Weng M, Chen W, Hou W, et al. The effect of neuraxial anesthesia on cancer recurrence and survival after cancer surgery: an updated meta-analysis [J]. Oncotarget, 2016,7(12):62-73.
[22] Lee B M, Ghotra V S, Karam J A, et al. Regional anesthesia/analgesia and the risk of cancer recurrence and mortality after prostatectomy: a meta-analysis [J]. Pain Manag, 2015,5(5):387-395.
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