麻醉和远期肿瘤结果比较：系统回顾和meta分析

贵州医科大学    麻醉与心脏电生理课题组

翻译：严旭           编辑：王波          审校：曹莹


背景

在癌症手术期间，异丙酚是否比挥发性麻醉剂具有生存益处尚无定论。这次系统回顾和meta分析的主要目的是将异丙酚全凭静脉麻醉（TIVA）与任何挥发性麻醉对远期肿瘤结果的影响进行比较。次要目的是将异丙酚TIVA与特定挥发性剂进行比较，以了解远期肿瘤结果。

方法


从成立到2020年3月3日，我们搜索了PubMed、Embase、Scopus、Web of Science和Cochrane图书馆。随机对照试验和观察研究比较了异丙酚TIVA和挥发性麻醉对远期肿瘤结果的影响，并将危害比（HR）列为效果估计，被认为有资格被纳入。使用随机效应模型的逆方差法，计算了HR和95%置信区间（CI）。采用了试验顺序分析来测试结果是否存在I型或II型错误。

结果

【罂粟摘要】麻醉和远期肿瘤结果比较：系统回顾和meta分析

包括19项回顾性观察研究。在癌症手术期间接受异丙酚TIVA的患者的总体生存率明显优于接受挥发性麻醉的患者（HR = 0.79，95% CI，0.66-0.94，P = .008，I2 = 82%）。相比之下，在癌症手术期间接受异丙酚TIVA和挥发性麻醉的患者之间没有观察到无复发生存率的统计学上的显著差异（HR = 0.81，95% CI，0.61-1.07，P = .137，I2 = 85%）。在不同挥发性麻醉剂的亚组分析中，接受异丙酚TIVA的患者与接受地氟醚的患者相比，整体生存率更好（HR = 0.54，95% CI，0.36-0.80，P = .003，I2 = 80%）。相比之下，接受异丙酚TIVA的患者和接受七氟醚的患者（HR = 0.92，95% CI，0.74-1.14，P = .439，I2 = 70%）的总体生存率没有统计学上的显著差异。在整体生存率的试验顺序分析中，累积Z曲线达到了所需的异质性调整信息大小，并跨越了传统的意义边界。相比之下，在无复发生存的试验顺序分析中，累积Z曲线没有跨越传统的意义边界。然而，所需的异质性调整信息大小尚未达到。


结论


      与癌症手术期间的挥发性麻醉药相比，异丙酚TIVA通常与更好的整体生存率有关。需要进一步的大规模、高质量的随机对照试验来证实我们的发现。

原始文献来源：Chun-Yu Chang, MD,*† Meng-Yu Wu, MD,†‡ Yung-Jiun Chien, MD,Anesthesia and Long-term Oncological Outcomes: A Systematic Review and Meta-analysis Copyright © 2020 International Anesthesia Research Society March 2021 · Volume 132 · Number 3 DOI: 10.1213/ANE.0000000000005237.

Anesthesia and Long-term Oncological Outcomes: A Systematic Review and Meta-analysis

Background:Whether propofol elicits a survival benefit over volatile anesthetics during cancer surgery remains inconclusive. The primary aim of this systematic review and meta-analysis is to compare the effects of propofol-based total intravenous anesthesia (TIVA) with any volatile anesthesia on long-term oncological outcomes. The secondary aim is to compare propofol-based TIVA with specific volatile agents on long-term oncological outcomes.

Methods:We searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library from inception through March 3, 2020. Randomized control trials and observational studies that compared the effects of propofol-based TIVA and volatile anesthesia on long-term oncological outcomes, which also reported hazard ratios (HR) as effect estimates, were considered eligible for inclusion. Using the inverse variance method with a random-effects model, HR and 95% confidence intervals (CI) were calculated. Trial sequential analysis was incorporated to test if the results were subject to a type I or type II error.

Results: Nineteen retrospective observational studies were included. Patients who received propofol-based TIVA during cancer surgery were associated with significantly better overall survival than those who received volatile anesthesia (HR = 0.79, 95% CI, 0.66-0.94, P = .008, I2 = 82%). In contrast, no statistically significant difference was observed in recurrence-free survival between patients who received propofol-based TIVA and volatile anesthesia during cancer surgery (HR = 0.81, 95% CI, 0.61-1.07, P = .137, I2 = 85%). In the subgroup analysis by different volatile anesthetics, patients who received propofol-based TIVA were associated with better overall survival than those who received desflurane (HR = 0.54, 95% CI, 0.36-0.80, P = .003, I2 = 80%). In contrast, there was no statistically significant difference in overall survival between patients who received propofol-based TIVA and those who received sevoflurane (HR = 0.92, 95% CI, 0.74-1.14, P = .439, I2 = 70%). In the trial sequential analysis of overall survival, the cumulative Z curve reached the required heterogeneity-adjusted information size and crossed the traditional significance boundary. In contrast, in the trial sequential analysis of recurrence-free survival, the cumulative Z curve did not cross the traditional significance boundary. However, the required heterogeneity-adjusted information size has not yet been reached.

Conclusions: Propofol-based TIVA is generally associated with better overall survival than volatile anesthesia during cancer surgery. Further large-scaled, high-quality randomized control trials are warranted to confirm our findings.

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