Propofol-based total intravenous anesthesia did not improve survival compared to desflurane anesthesia in breast cancer surgery
Breast cancer is the most common cancer in women and several perioperative factors may account for tumor recurrence and metastasis. The anesthetic agents employed during cancer surgery might play a crucial role in cancer cell survival and patient outcomes. We conducted a retrospective cohort study t...
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| Veröffentlicht in: | PloS one 2019-11, Vol.14 (11), p.e0224728-e0224728 |
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| creator | Huang, Yi-Hsuan Lee, Meei-Shyuan Lou, Yu-Sheng Lai, Hou-Chuan Yu, Jyh-Cherng Lu, Chueng-He Wong, Chih-Shung Wu, Zhi-Fu |
| description | Breast cancer is the most common cancer in women and several perioperative factors may account for tumor recurrence and metastasis. The anesthetic agents employed during cancer surgery might play a crucial role in cancer cell survival and patient outcomes. We conducted a retrospective cohort study to investigate the relationship between the type of anesthesia and overall survival in patients who underwent breast cancer surgery performed by one experienced surgeon.
All patients who underwent breast cancer surgery by an experienced surgeon between January 2006 and December 2010 were included in this study. Patients were separated into two groups according to the use of desflurane or propofol anesthesia during surgery. Locoregional recurrence and overall survival rates were assessed for the two groups (desflurane or propofol anesthesia). Univariable and multivariable Cox regression models and propensity score matching analyses were used to compare the hazard ratios for death and adjust for potential confounders (age, body mass index, American Society of Anesthesiologists physical status classification, TNM stage, neoadjuvant chemotherapy, Charlson Comorbidity Index, anesthesiologists, and functional status).
Of the 976 breast cancer patients, 632 patients underwent breast cancer surgery with desflurane anesthesia, while 344 received propofol anesthesia. After propensity scoring, 592 patients remained in the desflurane group and 296 patients in the propofol group. The mortality rate was similar in the desflurane (38 deaths, 4%) and propofol (22 deaths, 4%; p = 0.812) groups in 5-year follow-up. The crude hazard ratio (HR) for all patients was 1.13 (95% confidence interval [CI] 0.67-1.92, p = 0.646). No significant difference in the locoregional recurrence or overall 5-year survival rates were found after breast surgery using desflurane or propofol anesthesia (p = 0.454). Propensity score-matched analyses demonstrated similar outcomes in both groups. Patients who received propofol anesthesia had a higher mortality rate than those who received desflurane anesthesia in the matched groups (7% vs 6%, respectively) without significant difference (p = 0.561). In the propensity score-matched analyses, univariable analysis showed an insignificant finding (HR = 1.23, 95% CI 0.72-2.11, p = 0.449). After adjustment for the time since the earliest included patient, the HR remained insignificant (HR = 1.23, 95% CI 0.70-2.16, p = 0.475).
In our non-randomized retrospective a |
| doi_str_mv | 10.1371/journal.pone.0224728 |
| format | Article |
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All patients who underwent breast cancer surgery by an experienced surgeon between January 2006 and December 2010 were included in this study. Patients were separated into two groups according to the use of desflurane or propofol anesthesia during surgery. Locoregional recurrence and overall survival rates were assessed for the two groups (desflurane or propofol anesthesia). Univariable and multivariable Cox regression models and propensity score matching analyses were used to compare the hazard ratios for death and adjust for potential confounders (age, body mass index, American Society of Anesthesiologists physical status classification, TNM stage, neoadjuvant chemotherapy, Charlson Comorbidity Index, anesthesiologists, and functional status).
Of the 976 breast cancer patients, 632 patients underwent breast cancer surgery with desflurane anesthesia, while 344 received propofol anesthesia. After propensity scoring, 592 patients remained in the desflurane group and 296 patients in the propofol group. The mortality rate was similar in the desflurane (38 deaths, 4%) and propofol (22 deaths, 4%; p = 0.812) groups in 5-year follow-up. The crude hazard ratio (HR) for all patients was 1.13 (95% confidence interval [CI] 0.67-1.92, p = 0.646). No significant difference in the locoregional recurrence or overall 5-year survival rates were found after breast surgery using desflurane or propofol anesthesia (p = 0.454). Propensity score-matched analyses demonstrated similar outcomes in both groups. Patients who received propofol anesthesia had a higher mortality rate than those who received desflurane anesthesia in the matched groups (7% vs 6%, respectively) without significant difference (p = 0.561). In the propensity score-matched analyses, univariable analysis showed an insignificant finding (HR = 1.23, 95% CI 0.72-2.11, p = 0.449). After adjustment for the time since the earliest included patient, the HR remained insignificant (HR = 1.23, 95% CI 0.70-2.16, p = 0.475).
In our non-randomized retrospective analysis, neither propofol nor desflurane anesthesia for breast cancer surgery by an experienced surgeon can affect patient prognosis and survival. The influence of propofol anesthesia on breast cancer outcome requires further investigation.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0224728</identifier><identifier>PMID: 31697743</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adjuvant chemotherapy ; Adult ; Aged ; Anesthesia ; Anesthesia, Intravenous ; Anesthesiology ; Biology and Life Sciences ; Body mass ; Body mass index ; Body size ; Breast cancer ; Breast Neoplasms - surgery ; Breast surgery ; Cancer metastasis ; Cancer patients ; Cancer research ; Cancer surgery ; Cell survival ; Chemotherapy ; Comorbidity ; Comparative analysis ; Confidence intervals ; Desflurane - therapeutic use ; Fatalities ; Female ; Health hazards ; Hormone replacement therapy ; Hospital patients ; Hospitals ; Humans ; Intravenous administration ; Mastectomy ; Medical prognosis ; Medical records ; Medical research ; Medical societies ; Medicine and Health Sciences ; Metastases ; Metastasis ; Middle Aged ; Mortality ; Multivariate Analysis ; Narcotics ; Nonsteroidal anti-inflammatory drugs ; Patient outcomes ; People and Places ; Phenols (Class of compounds) ; Physicians ; Propensity Score ; Propofol ; Propofol - therapeutic use ; Proportional Hazards Models ; Public health ; Recurrence (Disease) ; Regression Analysis ; Regression models ; Statistical analysis ; Studies ; Surgeons ; Surgery ; Survival ; Systematic review ; Taiwan ; Tumors</subject><ispartof>PloS one, 2019-11, Vol.14 (11), p.e0224728-e0224728</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Huang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Huang et al 2019 Huang et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-87772281152463a055d4e04f533883805abb2d5b4f74f184e56f0dfed24666793</citedby><cites>FETCH-LOGICAL-c692t-87772281152463a055d4e04f533883805abb2d5b4f74f184e56f0dfed24666793</cites><orcidid>0000-0001-6376-9085</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837387/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837387/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31697743$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Yeh, Chun Chieh</contributor><creatorcontrib>Huang, Yi-Hsuan</creatorcontrib><creatorcontrib>Lee, Meei-Shyuan</creatorcontrib><creatorcontrib>Lou, Yu-Sheng</creatorcontrib><creatorcontrib>Lai, Hou-Chuan</creatorcontrib><creatorcontrib>Yu, Jyh-Cherng</creatorcontrib><creatorcontrib>Lu, Chueng-He</creatorcontrib><creatorcontrib>Wong, Chih-Shung</creatorcontrib><creatorcontrib>Wu, Zhi-Fu</creatorcontrib><title>Propofol-based total intravenous anesthesia did not improve survival compared to desflurane anesthesia in breast cancer surgery</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Breast cancer is the most common cancer in women and several perioperative factors may account for tumor recurrence and metastasis. The anesthetic agents employed during cancer surgery might play a crucial role in cancer cell survival and patient outcomes. We conducted a retrospective cohort study to investigate the relationship between the type of anesthesia and overall survival in patients who underwent breast cancer surgery performed by one experienced surgeon.
All patients who underwent breast cancer surgery by an experienced surgeon between January 2006 and December 2010 were included in this study. Patients were separated into two groups according to the use of desflurane or propofol anesthesia during surgery. Locoregional recurrence and overall survival rates were assessed for the two groups (desflurane or propofol anesthesia). Univariable and multivariable Cox regression models and propensity score matching analyses were used to compare the hazard ratios for death and adjust for potential confounders (age, body mass index, American Society of Anesthesiologists physical status classification, TNM stage, neoadjuvant chemotherapy, Charlson Comorbidity Index, anesthesiologists, and functional status).
Of the 976 breast cancer patients, 632 patients underwent breast cancer surgery with desflurane anesthesia, while 344 received propofol anesthesia. After propensity scoring, 592 patients remained in the desflurane group and 296 patients in the propofol group. The mortality rate was similar in the desflurane (38 deaths, 4%) and propofol (22 deaths, 4%; p = 0.812) groups in 5-year follow-up. The crude hazard ratio (HR) for all patients was 1.13 (95% confidence interval [CI] 0.67-1.92, p = 0.646). No significant difference in the locoregional recurrence or overall 5-year survival rates were found after breast surgery using desflurane or propofol anesthesia (p = 0.454). Propensity score-matched analyses demonstrated similar outcomes in both groups. Patients who received propofol anesthesia had a higher mortality rate than those who received desflurane anesthesia in the matched groups (7% vs 6%, respectively) without significant difference (p = 0.561). In the propensity score-matched analyses, univariable analysis showed an insignificant finding (HR = 1.23, 95% CI 0.72-2.11, p = 0.449). After adjustment for the time since the earliest included patient, the HR remained insignificant (HR = 1.23, 95% CI 0.70-2.16, p = 0.475).
In our non-randomized retrospective analysis, neither propofol nor desflurane anesthesia for breast cancer surgery by an experienced surgeon can affect patient prognosis and survival. The influence of propofol anesthesia on breast cancer outcome requires further investigation.</description><subject>Adjuvant chemotherapy</subject><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia</subject><subject>Anesthesia, Intravenous</subject><subject>Anesthesiology</subject><subject>Biology and Life Sciences</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - surgery</subject><subject>Breast surgery</subject><subject>Cancer metastasis</subject><subject>Cancer patients</subject><subject>Cancer research</subject><subject>Cancer surgery</subject><subject>Cell survival</subject><subject>Chemotherapy</subject><subject>Comorbidity</subject><subject>Comparative analysis</subject><subject>Confidence intervals</subject><subject>Desflurane - therapeutic use</subject><subject>Fatalities</subject><subject>Female</subject><subject>Health hazards</subject><subject>Hormone replacement therapy</subject><subject>Hospital patients</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intravenous administration</subject><subject>Mastectomy</subject><subject>Medical prognosis</subject><subject>Medical records</subject><subject>Medical research</subject><subject>Medical societies</subject><subject>Medicine and Health Sciences</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Narcotics</subject><subject>Nonsteroidal anti-inflammatory drugs</subject><subject>Patient outcomes</subject><subject>People and Places</subject><subject>Phenols (Class of compounds)</subject><subject>Physicians</subject><subject>Propensity Score</subject><subject>Propofol</subject><subject>Propofol - therapeutic use</subject><subject>Proportional Hazards Models</subject><subject>Public health</subject><subject>Recurrence (Disease)</subject><subject>Regression Analysis</subject><subject>Regression models</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Survival</subject><subject>Systematic review</subject><subject>Taiwan</subject><subject>Tumors</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk1trFDEcxQdRbF39BqIDgujDrrkn-yKU4mWhUPH2GjKTzG5KZjImmcU--dXNdKdlR_ogeUhIfuckOcm_KJ5DsIKYw3dXfgidcqved2YFECIciQfFKVxjtGQI4IdH45PiSYxXAFAsGHtcnGDI1pwTfFr8-RJ87xvvlpWKRpfJJ-VK26Wg9qbzQyxVZ2LamWhVqa0uO59K2_bB700Zh7C3-8zXvu1VuJGX2sTGDSHLjqW2K6tgVExlrbrahFG7NeH6afGoUS6aZ1O_KH58_PD9_PPy4vLT5vzsYlmzNUpLwTlHSEBIEWFYAUo1MYA0FGMhsABUVRXStCINJw0UxFDWAN0YnXHG-BovipcH3975KKfsokQYIr4WPJsuis2B0F5dyT7YVoVr6ZWVNxM-bKUKydbOSIw1FxoDIYAgnMKK6ppQDgkknEM0er2fdhuq1ujajHm6mel8pbM7ufV7yQTmWPBs8GYyCP7XkFOUrY21cS5Hmh9lPDfGXORAMvrqH_T-203UVuUL2K7xed96NJVnDFAgIOMoU6t7qNy0aW2dP1pj8_xM8HYmyEwyv9NWDTHKzbev_89e_pyzr4_YnVEu7aJ3Q7K-i3OQHMA6-BiDae5ChkCOdXKbhhzrRE51kmUvjh_oTnRbGPgv3bENaA</recordid><startdate>20191107</startdate><enddate>20191107</enddate><creator>Huang, Yi-Hsuan</creator><creator>Lee, Meei-Shyuan</creator><creator>Lou, Yu-Sheng</creator><creator>Lai, Hou-Chuan</creator><creator>Yu, Jyh-Cherng</creator><creator>Lu, Chueng-He</creator><creator>Wong, Chih-Shung</creator><creator>Wu, Zhi-Fu</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-6376-9085</orcidid></search><sort><creationdate>20191107</creationdate><title>Propofol-based total intravenous anesthesia did not improve survival compared to desflurane anesthesia in breast cancer surgery</title><author>Huang, Yi-Hsuan ; Lee, Meei-Shyuan ; Lou, Yu-Sheng ; Lai, Hou-Chuan ; Yu, Jyh-Cherng ; Lu, Chueng-He ; Wong, Chih-Shung ; Wu, Zhi-Fu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-87772281152463a055d4e04f533883805abb2d5b4f74f184e56f0dfed24666793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adjuvant chemotherapy</topic><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia</topic><topic>Anesthesia, Intravenous</topic><topic>Anesthesiology</topic><topic>Biology and Life Sciences</topic><topic>Body mass</topic><topic>Body mass index</topic><topic>Body size</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - surgery</topic><topic>Breast surgery</topic><topic>Cancer metastasis</topic><topic>Cancer patients</topic><topic>Cancer research</topic><topic>Cancer surgery</topic><topic>Cell survival</topic><topic>Chemotherapy</topic><topic>Comorbidity</topic><topic>Comparative analysis</topic><topic>Confidence intervals</topic><topic>Desflurane - therapeutic use</topic><topic>Fatalities</topic><topic>Female</topic><topic>Health hazards</topic><topic>Hormone replacement therapy</topic><topic>Hospital patients</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intravenous administration</topic><topic>Mastectomy</topic><topic>Medical prognosis</topic><topic>Medical records</topic><topic>Medical research</topic><topic>Medical societies</topic><topic>Medicine and Health Sciences</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Narcotics</topic><topic>Nonsteroidal anti-inflammatory drugs</topic><topic>Patient outcomes</topic><topic>People and Places</topic><topic>Phenols (Class of compounds)</topic><topic>Physicians</topic><topic>Propensity Score</topic><topic>Propofol</topic><topic>Propofol - therapeutic use</topic><topic>Proportional Hazards Models</topic><topic>Public health</topic><topic>Recurrence (Disease)</topic><topic>Regression Analysis</topic><topic>Regression models</topic><topic>Statistical analysis</topic><topic>Studies</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Survival</topic><topic>Systematic review</topic><topic>Taiwan</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huang, Yi-Hsuan</creatorcontrib><creatorcontrib>Lee, Meei-Shyuan</creatorcontrib><creatorcontrib>Lou, Yu-Sheng</creatorcontrib><creatorcontrib>Lai, Hou-Chuan</creatorcontrib><creatorcontrib>Yu, Jyh-Cherng</creatorcontrib><creatorcontrib>Lu, Chueng-He</creatorcontrib><creatorcontrib>Wong, Chih-Shung</creatorcontrib><creatorcontrib>Wu, Zhi-Fu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huang, Yi-Hsuan</au><au>Lee, Meei-Shyuan</au><au>Lou, Yu-Sheng</au><au>Lai, Hou-Chuan</au><au>Yu, Jyh-Cherng</au><au>Lu, Chueng-He</au><au>Wong, Chih-Shung</au><au>Wu, Zhi-Fu</au><au>Yeh, Chun Chieh</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Propofol-based total intravenous anesthesia did not improve survival compared to desflurane anesthesia in breast cancer surgery</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-11-07</date><risdate>2019</risdate><volume>14</volume><issue>11</issue><spage>e0224728</spage><epage>e0224728</epage><pages>e0224728-e0224728</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Breast cancer is the most common cancer in women and several perioperative factors may account for tumor recurrence and metastasis. The anesthetic agents employed during cancer surgery might play a crucial role in cancer cell survival and patient outcomes. We conducted a retrospective cohort study to investigate the relationship between the type of anesthesia and overall survival in patients who underwent breast cancer surgery performed by one experienced surgeon.
All patients who underwent breast cancer surgery by an experienced surgeon between January 2006 and December 2010 were included in this study. Patients were separated into two groups according to the use of desflurane or propofol anesthesia during surgery. Locoregional recurrence and overall survival rates were assessed for the two groups (desflurane or propofol anesthesia). Univariable and multivariable Cox regression models and propensity score matching analyses were used to compare the hazard ratios for death and adjust for potential confounders (age, body mass index, American Society of Anesthesiologists physical status classification, TNM stage, neoadjuvant chemotherapy, Charlson Comorbidity Index, anesthesiologists, and functional status).
Of the 976 breast cancer patients, 632 patients underwent breast cancer surgery with desflurane anesthesia, while 344 received propofol anesthesia. After propensity scoring, 592 patients remained in the desflurane group and 296 patients in the propofol group. The mortality rate was similar in the desflurane (38 deaths, 4%) and propofol (22 deaths, 4%; p = 0.812) groups in 5-year follow-up. The crude hazard ratio (HR) for all patients was 1.13 (95% confidence interval [CI] 0.67-1.92, p = 0.646). No significant difference in the locoregional recurrence or overall 5-year survival rates were found after breast surgery using desflurane or propofol anesthesia (p = 0.454). Propensity score-matched analyses demonstrated similar outcomes in both groups. Patients who received propofol anesthesia had a higher mortality rate than those who received desflurane anesthesia in the matched groups (7% vs 6%, respectively) without significant difference (p = 0.561). In the propensity score-matched analyses, univariable analysis showed an insignificant finding (HR = 1.23, 95% CI 0.72-2.11, p = 0.449). After adjustment for the time since the earliest included patient, the HR remained insignificant (HR = 1.23, 95% CI 0.70-2.16, p = 0.475).
In our non-randomized retrospective analysis, neither propofol nor desflurane anesthesia for breast cancer surgery by an experienced surgeon can affect patient prognosis and survival. The influence of propofol anesthesia on breast cancer outcome requires further investigation.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31697743</pmid><doi>10.1371/journal.pone.0224728</doi><tpages>e0224728</tpages><orcidid>https://orcid.org/0000-0001-6376-9085</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-11, Vol.14 (11), p.e0224728-e0224728 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2312798746 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adjuvant chemotherapy Adult Aged Anesthesia Anesthesia, Intravenous Anesthesiology Biology and Life Sciences Body mass Body mass index Body size Breast cancer Breast Neoplasms - surgery Breast surgery Cancer metastasis Cancer patients Cancer research Cancer surgery Cell survival Chemotherapy Comorbidity Comparative analysis Confidence intervals Desflurane - therapeutic use Fatalities Female Health hazards Hormone replacement therapy Hospital patients Hospitals Humans Intravenous administration Mastectomy Medical prognosis Medical records Medical research Medical societies Medicine and Health Sciences Metastases Metastasis Middle Aged Mortality Multivariate Analysis Narcotics Nonsteroidal anti-inflammatory drugs Patient outcomes People and Places Phenols (Class of compounds) Physicians Propensity Score Propofol Propofol - therapeutic use Proportional Hazards Models Public health Recurrence (Disease) Regression Analysis Regression models Statistical analysis Studies Surgeons Surgery Survival Systematic review Taiwan Tumors |
| title | Propofol-based total intravenous anesthesia did not improve survival compared to desflurane anesthesia in breast cancer surgery |
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