全身麻醉復合硬膜外麻醉對腫瘤患者預后影響的Meta分析_《中國循證醫學雜志》

作者：

常小麗 , 朱丹 ,  任許利呂黃偉

中國醫科大學附屬第一醫院麻醉科（沈陽?110001）;

關鍵詞：

全身麻醉硬膜外麻醉腫瘤復發腫瘤轉移 Meta分析系統評價

DOI：

10.7507/1672-2531.20110159

視頻：

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目的　系統評價全身麻醉復合硬膜外麻醉對腫瘤患者預后的影響。
方法　計算機檢索PubMed、OVID、EBSCO、Cochrane圖書館和CNKI，并手工檢索相關雜志以及納入文獻的參考文獻，檢索時限為1986～2011年。由兩名評價者按照納入與排除標準獨立選擇試驗，提取資料和評估方法學質量后，采用RevMan 5.0軟件進行Meta分析。
結果　最終納入7個研究，合計2 513例患者，7篇文獻Jadad評分均在3分以上。Meta分析結果顯示：全身麻醉復合硬膜外麻醉與單純全身麻醉相比，其患者術后轉移復發率差異無統計學差異［OR=0.71，95%CI（0.44，1.17），P=0.18］。按腫瘤類型、隨訪時間、術前有無轉移和患者年齡4個因素進行敏感性分析，結果顯示在高齡組（≥64歲）和短期隨訪組（≤2年），兩種麻醉方式術后復發轉移率差異有統計學意義［OR=1.46，95%CI（1.00，2.14），P=0.05；OR=1.55，95%CI（1.06，2.26），P=0.02）］，但在結直腸癌組和術前無轉移組兩種麻醉方式的術后復發轉移率差異無統計學意義［OR=1.00，95%CI（0.62，1.61），P=0.99；OR=1.26，95%CI（0.86，1.86），P=0.23］。
結論　硬膜外麻醉聯合全身麻醉與單純全麻相比較，不能降低癌癥患者術后腫瘤復發轉移率。年齡≥64歲和隨訪時間≤2年的患者應用硬膜外麻醉聯合全身麻醉時，其遠期復發轉移率明顯低于單純全麻；結直腸癌患者和術前無轉移患者預后無明顯改善。

引用本文： 常小麗,朱丹,任許利呂黃偉. 全身麻醉復合硬膜外麻醉對腫瘤患者預后影響的Meta分析. 中國循證醫學雜志, 2011, 11(8): 954-959. doi: 10.7507/1672-2531.20110159 復制

1.	Sessler DI. Does regional analgesia reduce the risk of cancer recurrence? A hypothesis. Eur J Cancer Prev , 2008, 17(3): 269-272.
2.	Gupta GP, Massague J. Cancer metastasis: Building a framework. Cell , 2006, 127(17): 679-695.
3.	Hedley BD, Chambers AF. Tumor dormancy and metastasis. Adv Cancer Res , 2009, 102: 67-101.
4.	Jadad AR, Moore RA, Carroll D, et al . Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials , 1996, 17(1): 1-12.
5.	Gottschalk A, Ford JG, Regelin CC, et al . Association between epidural analgesia and cancer recurrence after colorectal cancer surgery. Anesthesiology , 2010, 113(1): 27-34.
6.	Exadaktylos AK, Buggy DJ, Moriarty DC, et al . Can Anesthetic Technique for Primary Breast Cancer Surgery Affect Recurrence or Metastasis? Anesthesiology , 2006, 105(4): 660-664.
7.	Tsui BC, Rashiq S, Schopflocher D, et al . Epidural anesthesia and cancer recurrence rates after radical Prostatectomy. Can J Anesth , 2010, 57(2): 107-112.
8.	Christopherson R, James KE, Tableman M, et al . Long-Term Survival After Colon Cancer Surgery: A Variation Associated with Choice of Anesthesia. Anesth Analg , 2008, 107(1): 325-332.
9.	Wuethrich PY, Hsu Schmitz SF, Kessler TM, et al . Potential Influence of the Anesthetic Technique Used during Open Radical Prostatectomy on Prostate Cancer-related Outcome. Anesthesiology , 2010, 113(3): 570-6.
10.	Luo CF, Su B. Analgesic technique for primary colon cancer surgery doesn’t affect cancer recurrence. Anesth Analg , 2010, 14AP8-4.
11.	Biki B, Mascha E, Moriarty DC, et al . Anesthetic technique for radical prostatectomy surgery affects cancer recurrence a retrospective analysis. Anesthesiology , 2008, 109(2): 180-187.
12.	Sessler DI, Ben ES, Mascha EJ, et al . General anaesthesia vs local anaesthesia: an ongoing story. Br J Anaesth , 2009, 103(6): 785-789.
13.	Snyder GL, Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. Br J Anaesth , 2010, 105(2): 106-115.
14.	Vila H Jr, Liu J, Kavasmaneck D. Paravertebral block: new benefits from an old procedure. Curr Opin Anaesthesiol , 2007, 20(4): 316-318.
15.	Gottschalk A, Sharma S, Ford J, et al . The role of the perioperative period in recurrence after cancer surgery. Anesth Analg , 2010, 110(5): 1636-1643.
16.	Shakhar G, Ben-Eliyahu S. Potential Prophylactic Measures Against Postoperative Immuno suppression: Could They Reduce Recurrence Rates in Oncological Patients. Annals of Surgical Oncology , 2003, 10(8): 972-992.
17.	Forget P, De Kock M. Could anaesthesia, analgesia and sympathetic modulation affect neoplasic recurrence after surgery? A systematic review centred over the modulation of natural killer cells activity. Ann Fr Anesth Reanim , 2009, 28(9): 751-768.
18.	Moss J, Israel RJ. Effects of Anesthetics on Cancer Recurrence. J Clin Onco , 2009, 27(25): e89.
19.	Curatolo, Michele. Adding regional analgesia to general anaesthesia: increase of risk or improved outcome? Eur J Cancer Prev , 2010, 27(7): 586-591.
20.	Singleton PA, Moss J. Effect of perioperative opioids on cancer recurrence: a hypothesis. Future Oncol , 2010, 6(8): 1237-1242.
21.	Frank E, Sood OP, Torjman M, et al . Postoperative epidural analgesia following radical retropubic prostatectomy: outcome assessment. J Surg Oncol , 1998, 67(2): 117-120.
22.	Freedland SJ, Humphreys EB, Mangold LA, et al . Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA , 2005, 294: 433-439.
23.	Biki B, Mascha E, Moriarty DC, et al . Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology , 2008, 109(2): 180-187.
24.	Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology , 2006, 105: 660-664.
25.	Forget P, Vandenhende J, Berliere M, et al . Do intraoperative analgesics influence breast cancer recurrence after mastectomy? A retrospective analysis. Anesth Analg , 2010, 110: 1630-1635.
26.	Gupta K, Kshirsagar S, Chang L, et al . Morphine stimulates angiogenesis by activating proangiogenic and survival-promoting signaling and promotes breast tumor growth. Clin Cancer Res , 2002, 62: 4491-4498.
27.	Sessler DI, Ben ES, Mascha EJ, et al . Can regional analgesia reduce the risk of recurrence after breast cancer? Methodology of a multicenter randomized trial. Contemp Clin Trials , 2008, 29: 517-526.
28.	Soerjomataram I, Louwman MW, Ribot JG, et al . An overview of prognostic factors for long term survivors of breast cancer. Breast Cancer Res Treat , 2008, 107(4): 309-330.
29.	Brian M. Parker, MD. Anesthetics and anesthesia techniques: Impacts on perioperative management and postoperative outcomes. Cleveland Clinic Journal of Medicine , 2006, 73: SUPPLEMENT 1.
30.	Rodgers A, Walker N, Schug S, et al . Reduction of postoperative mortality, morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. Br J Anaesth , 2000, 321(3): 1493.
31.	Bovill JG. Surgery for Cancer: Does Anesthesia Matter? Anesth Analg , 2010, 110: 1524-1526.
32.	Kurosawa S, Kato M. Anesthetics, immune cells, and immune responses. J Anesth , 2008, 22: 263-277.
33.	O'Riain SC, Buggy DJ, Kerin MJ, et al . Inhibition of the stress response to breast cancer surgery by regional anesthesia and analgesia does not affect vascular endothelial growth factor and prostaglandin E2. Anesth Analg , 2005, 100(1): 244-249.
34.	Munoz M, Rosso M, Casinello F, et al . Paravertebral anesthesia: how substance P and the NK-1 receptor could be involved in regional block and breast cancer recurrence. Breast Cancer Res Treat , 2010, 122(2): 601-603.
35.	Benish M, Ben-Eliyahu S. Surgery as a Double-Edged Sword: A Clinically Feasible Approach to Overcome the Metastasis-Promoting Effects of Surgery by Blunting Stress and Prostaglandin Responses. Cancers , 2010, 2(5): 1929-1951.
36.	Wada H, Seki S, Takahashi T, et al . Combined spinal and general anesthesia attenuates liver metastasis by preserving TH1/TH2 cytokine balance. Anesthesiology , 2007, 106(3): 499-506.
37.	Looney M, Doran P, Buggy DJ. Effect of anesthetic technique on serum vascular endothelial growth factor C and transforming growth factor β in women undergoing anesthesia and surgery for breast cancer. Anesthesiology , 2010, 113(5): 1118-1125.
38.	Weckermann D, Polzer B, Ragg T, et al . Perioperative activation of disseminated tumor cells in bone marrow of patients with prostate cancer. J Clin Oncol , 2009, 27(10): 1549-1556.
39.	Deegan CA, Murray D, Doran P, et al . Anesthetic technique and the cytokine and matrix metalloproteinase response to primary breast cancer surgery. Reg Anesth Pain Med, 2010, 35(6): 490-495.
40.	Jeremy B. Swann Mark J. Smyth. Immune surveillance of tumors. Clin Invest , 2010, 117(5): 1137-1146.
41.	DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials , 1986, 7(3): 177-188.
42.	LeLorier J, Gregoire G, Benhaddad A, et al . Discrepancies between meta-analyses and subsequent large randomized, controlled trials. N Engl J Med , 1997, 337(8): 536-542.

1. Sessler DI. Does regional analgesia reduce the risk of cancer recurrence? A hypothesis. Eur J Cancer Prev , 2008, 17(3): 269-272.
2. Gupta GP, Massague J. Cancer metastasis: Building a framework. Cell , 2006, 127(17): 679-695.
3. Hedley BD, Chambers AF. Tumor dormancy and metastasis. Adv Cancer Res , 2009, 102: 67-101.
4. Jadad AR, Moore RA, Carroll D, et al . Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials , 1996, 17(1): 1-12.
5. Gottschalk A, Ford JG, Regelin CC, et al . Association between epidural analgesia and cancer recurrence after colorectal cancer surgery. Anesthesiology , 2010, 113(1): 27-34.
6. Exadaktylos AK, Buggy DJ, Moriarty DC, et al . Can Anesthetic Technique for Primary Breast Cancer Surgery Affect Recurrence or Metastasis? Anesthesiology , 2006, 105(4): 660-664.
7. Tsui BC, Rashiq S, Schopflocher D, et al . Epidural anesthesia and cancer recurrence rates after radical Prostatectomy. Can J Anesth , 2010, 57(2): 107-112.
8. Christopherson R, James KE, Tableman M, et al . Long-Term Survival After Colon Cancer Surgery: A Variation Associated with Choice of Anesthesia. Anesth Analg , 2008, 107(1): 325-332.
9. Wuethrich PY, Hsu Schmitz SF, Kessler TM, et al . Potential Influence of the Anesthetic Technique Used during Open Radical Prostatectomy on Prostate Cancer-related Outcome. Anesthesiology , 2010, 113(3): 570-6.
10. Luo CF, Su B. Analgesic technique for primary colon cancer surgery doesn’t affect cancer recurrence. Anesth Analg , 2010, 14AP8-4.
11. Biki B, Mascha E, Moriarty DC, et al . Anesthetic technique for radical prostatectomy surgery affects cancer recurrence a retrospective analysis. Anesthesiology , 2008, 109(2): 180-187.
12. Sessler DI, Ben ES, Mascha EJ, et al . General anaesthesia vs local anaesthesia: an ongoing story. Br J Anaesth , 2009, 103(6): 785-789.
13. Snyder GL, Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. Br J Anaesth , 2010, 105(2): 106-115.
14. Vila H Jr, Liu J, Kavasmaneck D. Paravertebral block: new benefits from an old procedure. Curr Opin Anaesthesiol , 2007, 20(4): 316-318.
15. Gottschalk A, Sharma S, Ford J, et al . The role of the perioperative period in recurrence after cancer surgery. Anesth Analg , 2010, 110(5): 1636-1643.
16. Shakhar G, Ben-Eliyahu S. Potential Prophylactic Measures Against Postoperative Immuno suppression: Could They Reduce Recurrence Rates in Oncological Patients. Annals of Surgical Oncology , 2003, 10(8): 972-992.
17. Forget P, De Kock M. Could anaesthesia, analgesia and sympathetic modulation affect neoplasic recurrence after surgery? A systematic review centred over the modulation of natural killer cells activity. Ann Fr Anesth Reanim , 2009, 28(9): 751-768.
18. Moss J, Israel RJ. Effects of Anesthetics on Cancer Recurrence. J Clin Onco , 2009, 27(25): e89.
19. Curatolo, Michele. Adding regional analgesia to general anaesthesia: increase of risk or improved outcome? Eur J Cancer Prev , 2010, 27(7): 586-591.
20. Singleton PA, Moss J. Effect of perioperative opioids on cancer recurrence: a hypothesis. Future Oncol , 2010, 6(8): 1237-1242.
21. Frank E, Sood OP, Torjman M, et al . Postoperative epidural analgesia following radical retropubic prostatectomy: outcome assessment. J Surg Oncol , 1998, 67(2): 117-120.
22. Freedland SJ, Humphreys EB, Mangold LA, et al . Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA , 2005, 294: 433-439.
23. Biki B, Mascha E, Moriarty DC, et al . Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology , 2008, 109(2): 180-187.
24. Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology , 2006, 105: 660-664.
25. Forget P, Vandenhende J, Berliere M, et al . Do intraoperative analgesics influence breast cancer recurrence after mastectomy? A retrospective analysis. Anesth Analg , 2010, 110: 1630-1635.
26. Gupta K, Kshirsagar S, Chang L, et al . Morphine stimulates angiogenesis by activating proangiogenic and survival-promoting signaling and promotes breast tumor growth. Clin Cancer Res , 2002, 62: 4491-4498.
27. Sessler DI, Ben ES, Mascha EJ, et al . Can regional analgesia reduce the risk of recurrence after breast cancer? Methodology of a multicenter randomized trial. Contemp Clin Trials , 2008, 29: 517-526.
28. Soerjomataram I, Louwman MW, Ribot JG, et al . An overview of prognostic factors for long term survivors of breast cancer. Breast Cancer Res Treat , 2008, 107(4): 309-330.
29. Brian M. Parker, MD. Anesthetics and anesthesia techniques: Impacts on perioperative management and postoperative outcomes. Cleveland Clinic Journal of Medicine , 2006, 73: SUPPLEMENT 1.
30. Rodgers A, Walker N, Schug S, et al . Reduction of postoperative mortality, morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. Br J Anaesth , 2000, 321(3): 1493.
31. Bovill JG. Surgery for Cancer: Does Anesthesia Matter? Anesth Analg , 2010, 110: 1524-1526.
32. Kurosawa S, Kato M. Anesthetics, immune cells, and immune responses. J Anesth , 2008, 22: 263-277.
33. O'Riain SC, Buggy DJ, Kerin MJ, et al . Inhibition of the stress response to breast cancer surgery by regional anesthesia and analgesia does not affect vascular endothelial growth factor and prostaglandin E2. Anesth Analg , 2005, 100(1): 244-249.
34. Munoz M, Rosso M, Casinello F, et al . Paravertebral anesthesia: how substance P and the NK-1 receptor could be involved in regional block and breast cancer recurrence. Breast Cancer Res Treat , 2010, 122(2): 601-603.
35. Benish M, Ben-Eliyahu S. Surgery as a Double-Edged Sword: A Clinically Feasible Approach to Overcome the Metastasis-Promoting Effects of Surgery by Blunting Stress and Prostaglandin Responses. Cancers , 2010, 2(5): 1929-1951.
36. Wada H, Seki S, Takahashi T, et al . Combined spinal and general anesthesia attenuates liver metastasis by preserving TH1/TH2 cytokine balance. Anesthesiology , 2007, 106(3): 499-506.
37. Looney M, Doran P, Buggy DJ. Effect of anesthetic technique on serum vascular endothelial growth factor C and transforming growth factor β in women undergoing anesthesia and surgery for breast cancer. Anesthesiology , 2010, 113(5): 1118-1125.
38. Weckermann D, Polzer B, Ragg T, et al . Perioperative activation of disseminated tumor cells in bone marrow of patients with prostate cancer. J Clin Oncol , 2009, 27(10): 1549-1556.
39. Deegan CA, Murray D, Doran P, et al . Anesthetic technique and the cytokine and matrix metalloproteinase response to primary breast cancer surgery. Reg Anesth Pain Med, 2010, 35(6): 490-495.
40. Jeremy B. Swann Mark J. Smyth. Immune surveillance of tumors. Clin Invest , 2010, 117(5): 1137-1146.
41. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials , 1986, 7(3): 177-188.
42. LeLorier J, Gregoire G, Benhaddad A, et al . Discrepancies between meta-analyses and subsequent large randomized, controlled trials. N Engl J Med , 1997, 337(8): 536-542.

《中國循證醫學雜志》

全身麻醉復合硬膜外麻醉對腫瘤患者預后影響的Meta分析

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《中國循證醫學雜志》

全身麻醉復合硬膜外麻醉對腫瘤患者預后影響的Meta分析

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