麻醉影响癌细胞转移吗？

麻醉对肿瘤患者的影响存在争议，有的研究认为麻醉可能与肿瘤的转移有关，不同麻醉药的影响存在差异，这篇发表在Anesthesiology杂志上的随机对照研究对接受七氟烷的病人术后肿瘤细胞计数会更高这个假设进行了验证，结果如何呢？一起看看摘要吧！有兴趣的可下载全文了解更详细的信息！

麻醉与原发性乳腺癌患者循环中的肿瘤细胞：一项随机对照研究

背景：麻醉药物对癌症患者预后的影响尚不清楚。本试验旨在检测术后循环中肿瘤细胞计数（乳腺癌的独立预后因素），以确定麻醉如何间接影响预后。假设接受七氟烷的病人术后肿瘤细胞计数会更高。

方法：在瑞士的两个医学中心进行该项平行随机对照临床试验。入选条件：年龄在18岁至85岁之间，无远处转移，并计划进行原发性乳腺癌手术。患者被随机分配到七氟烷麻醉组或异丙酚麻醉组。患者和结果评估者双盲。主要结果是循环中肿瘤细胞计数，在术后（0、48和72小时）三个时间点计数分析循环肿瘤细胞。次要结果包括最大循环肿瘤细胞值、阳性率（截止值：至少1个和至少5个肿瘤细胞/7.5ml血液），以及自然杀伤细胞活性与肿瘤细胞计数之间的关系。本次试验已在ClinicalTrials.gov注册（NCT02005770）。

结果：2014年3月至2018年4月，共有210名受试者被分为七氟烷麻醉组（n=107）或异丙酚麻醉组（n=103），并被最终纳入分析。麻醉类型对循环肿瘤细胞计数无影响（循环肿瘤细胞计数中位数[四分位范围]；异丙酚麻醉组：0小时时1[0-4]，48小时1[0-2]，72小时0[0-1]；七氟烷麻醉：0小时1[0-4]，48小时0[0-2]，72小时1[0-2]；比值比或阳性率1.27[95%CI，0.95-1.71]；P=0.103）。次要结果中，使用七氟醚导致术后最大肿瘤细胞计数显著增加。自然杀伤细胞活性与循环肿瘤细胞计数无相关性。

结论：这项随机对照试验研究麻醉对乳腺癌独立预后因素的影响，七氟醚和异丙酚对随时间的推移的循环肿瘤细胞计数的影响没有统计学差异。

关于这个话题我们已经知道的：

麻醉可能有助于肿瘤在外科治疗中的远处转移。在非转移性和转移性乳腺癌中，循环肿瘤细胞的存在与疾病复发的高风险和生存率的降低独立相关。

这篇文章告诉我们的是新的：

这项包含210名患者的临床随机对照试验检验了七氟烷麻醉的原发性乳腺癌患者术后循环肿瘤细胞计数高于异丙酚静脉麻醉的假设，结果显示无统计学差异，中位循环肿瘤细胞计数/7.5ml血液[四分位范围]：异丙酚麻醉组，手术结束（0 h）时为1[0-4]，48小时为1[0-2]，72小时为0[0-1]；七氟烷麻醉组0小时为1[0-4]，48小时为0[0-2]，72小时为1[0-2]；比值比为1.27[95%CI，0.95-1.71]）。

Anesthesia and Circulating Tumor Cells in Primary Breast Cancer Patients: A Randomized Controlled Trial

Background: The effect of anesthetic drugs on cancer outcomes remains unclear. This trial aimed to assess postoperative circulating tumor cell counts-an independent prognostic factor for breast cancer-to determine how anesthesia may indirectly affect prognosis. It was hypothesized that patients receiving sevoflurane would have higher postoperative tumor cell counts.

Methods: The parallel, randomized controlled trial was conducted in two centers in Switzerland. Patients aged 18 to 85 yr without metastases and scheduled for primary breast cancer surgery were eligible. The patients were randomly assigned to either sevoflurane or propofol anesthesia. The patients and outcome assessors were blinded. The primary outcome was circulating tumor cell counts over time, assessed at three time points postoperatively (0, 48, and 72 h) by the CellSearch assay. Secondary outcomes included maximal circulating tumor cells value, positivity (cutoff: at least 1 and at least 5 tumor cells/7.5 ml blood), and the association between natural killer cell activity and tumor cell counts. This trial was registered with ClinicalTrials.gov (NCT02005770).

Results: Between March 2014 and April 2018, 210 participants were enrolled, assigned to sevoflurane (n = 107) or propofol (n = 103) anesthesia, and eventually included in the analysis. Anesthesia type did not affect circulating tumor cell counts over time (median circulating tumor cell count [interquartile range]; for propofol: 1 [0 to 4] at 0 h, 1 [0 to 2] at 48 h, and 0 [0 to 1] at 72 h; and for sevoflurane: 1 [0 to 4] at 0 h, 0 [0 to 2] at 48 h, and 1 [0 to 2] at 72 h; rate ratio, 1.27 [95% CI, 0.95 to 1.71]; P = 0.103) or positivity. In one secondary analysis, administrating sevoflurane led to a significant increase in maximal tumor cell counts postoperatively. There was no association between natural killer cell activity and circulating tumor cell counts.

Conclusions: In this randomized controlled trial investigating the effect of anesthesia on an independent prognostic factor for breast cancer, there was no difference between sevoflurane and propofol with respect to circulating tumor cell counts over time. 

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: 

Anesthesia may contribute to the distant spread of cancer during surgical treatmentThe presence of circulating tumor cells has been independently associated with both a higher risk of disease recurrence and reduced survival in both nonmetastatic and metastatic breast cancer. 

WHAT THIS ARTICLE TELLS US THAT IS NEW: 

The hypothesis that postoperative circulating tumor cell counts would be higher in primary breast cancer patients receiving sevoflurane anesthesia than in those receiving intravenous anesthesia with propofol was tested in a randomized controlled trial of 210 patients. The type of anesthesia did not affect circulating tumor cell counts over time (median circulating tumor cell count/7.5 ml blood [interquartile range]: for propofol, 1 [0 to 4] at end of surgery (0 h), 1 [0 to 2] at 48 h, and 0 [0 to 1] at 72 h; and for sevoflurane, 1 [0 to 4] at 0 h, 0 [0 to 2] at 48 h, and 1 [0 to 2] at 72 h; rate ratio, 1.27 [95% CI, 0.95 to 1.71]).