无论是麻醉技术,吸入全身麻醉(IGA)或基于丙泊酚的麻醉(PBA),影响非转移性乳腺癌(eBC)的长期生存率仍不清楚且存在争议.我们在7月16日进行了一次文献检索,2022年用于比较接受标准手术的eBC中IGA和PBA的研究,根据PRISMA2020。我们研究的主要终点是总生存期(OS)。荟萃分析包括17项研究,包括4项随机临床试验和13项回顾性队列研究。10项研究提供了未加权eBC患者的粗OS数据(基线特征失衡)。PBA组与IGA组的估计HR汇总(十项研究,N=127,774,IGA组:92,592,PBA组:35,182。)为0.83(95CI:0.78-0.89)。与IGA相比,PBA与更好的1年OS相关(两项研究,N=104,083,IGA组:84,074,PBA组:20,009。集合HR=0.80,0.73-0.89)和5年OS(6项研究,N=121,580,IGA组:89,472,PBA组:32,108。HR=0.80,0.74-0.87)。10项研究应用PSM方法来平衡基线特征。在这些加权的患者中,PBA仍然显示出更好的操作系统(10项研究,N=105,459,IGA组:79,095,PBA组:26,364。HR=0.93,0.87-1.00),更好的1年OS(两项研究,N=83,007,IGA组:67,609,PBA组:15,398。HR=0.88,0.78-0.98)和朝着更好的5年OS方向发展的趋势(9项研究,N=121,580,IGA组:76,797,PBA组:24,066。HR=0.95,0.88-1.03)。PBA组的局部区域无复发生存率(LRRFS)也更好(HR=0.73,0.61-0.86)。本研究是第一个全面的荟萃分析,证明异丙酚麻醉可以显着改善非转移性乳腺癌患者的OS和LRFS。与吸入麻醉相比。
Whether the anesthesia technique, inhalational general anesthesia (IGA) or propofol-based anesthesia (PBA), influences the long-term survival of non-metastatic breast cancer (eBC) remain unclear and controversial. We carried out a literature search on 16thJuly, 2022 for studies comparing IGA and PBA in eBC undergoing standard surgery, according to PRISMA 2020. The major endpoint in our study was overall survival (OS). Seventeen studies including four randomized clinical trials and thirteen retrospective cohort studies were included in the meta-analysis. Ten studies provided data for crude OS in unweighted eBC patients (imbalance in baseline characteristics). The summarized estimate HRs of the PBA group versus the IGA group (ten studies, N = 127,774, IGA group: 92,592, PBA group: 35,182.) was 0.83 (95%CI: 0.78-0.89). Compared with IGA, PBA was associated with both better 1-year OS (two studies, N = 104,083, IGA group: 84,074, PBA group: 20,009. Pooled HR = 0.80, 0.73-0.89) and 5-year OS (six studies, N = 121,580, IGA group: 89,472, PBA group: 32,108. HR = 0.80, 0.74-0.87). Ten studies applied PSM method to balance the baseline characteristics. In these weighted patients, PBA still showed a better OS (ten studies, N = 105,459, IGA group: 79,095, PBA group: 26,364. HR = 0.93, 0.87-1.00), a better 1-year OS (two studies, N = 83,007, IGA group: 67,609, PBA group: 15,398. HR = 0.88, 0.78-0.98) and a trend towards a better 5-year OS (nine studies, N = 121,580, IGA group: 76,797, PBA group: 24,066. HR = 0.95, 0.88-1.03). Loco-regional recurrence-free survival (LRRFS) was also better in PBA group (HR = 0.73, 0.61-0.86). The present study is the first comprehensive meta-analysis to demonstrate that propofol-based anesthesia could significantly improve OS and LRRFS in non-metastatic breast cancer patients, compared with inhalational anesthesia.