全身麻醉复合硬膜外麻醉对肿瘤患者预后影响的Meta分析_《中国循证医学杂志》

作者：

常小丽 , 朱丹 ,  任许利吕黄伟

中国医科大学附属第一医院麻醉科（沈阳?110001）;

关键词：

全身麻醉硬膜外麻醉肿瘤复发肿瘤转移 Meta分析系统评价

DOI：

10.7507/1672-2531.20110159

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价全身麻醉复合硬膜外麻醉对肿瘤患者预后的影响。
方法　计算机检索PubMed、OVID、EBSCO、Cochrane图书馆和CNKI，并手工检索相关杂志以及纳入文献的参考文献，检索时限为1986～2011年。由两名评价者按照纳入与排除标准独立选择试验，提取资料和评估方法学质量后，采用RevMan 5.0软件进行Meta分析。
结果　最终纳入7个研究，合计2 513例患者，7篇文献Jadad评分均在3分以上。Meta分析结果显示：全身麻醉复合硬膜外麻醉与单纯全身麻醉相比，其患者术后转移复发率差异无统计学差异［OR=0.71，95%CI（0.44，1.17），P=0.18］。按肿瘤类型、随访时间、术前有无转移和患者年龄4个因素进行敏感性分析，结果显示在高龄组（≥64岁）和短期随访组（≤2年），两种麻醉方式术后复发转移率差异有统计学意义［OR=1.46，95%CI（1.00，2.14），P=0.05；OR=1.55，95%CI（1.06，2.26），P=0.02）］，但在结直肠癌组和术前无转移组两种麻醉方式的术后复发转移率差异无统计学意义［OR=1.00，95%CI（0.62，1.61），P=0.99；OR=1.26，95%CI（0.86，1.86），P=0.23］。
结论　硬膜外麻醉联合全身麻醉与单纯全麻相比较，不能降低癌症患者术后肿瘤复发转移率。年龄≥64岁和随访时间≤2年的患者应用硬膜外麻醉联合全身麻醉时，其远期复发转移率明显低于单纯全麻；结直肠癌患者和术前无转移患者预后无明显改善。

引用本文： 常小丽,朱丹,任许利吕黄伟. 全身麻醉复合硬膜外麻醉对肿瘤患者预后影响的Meta分析. 中国循证医学杂志, 2011, 11(8): 954-959. doi: 10.7507/1672-2531.20110159 复制

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3.	Hedley BD, Chambers AF. Tumor dormancy and metastasis. Adv Cancer Res , 2009, 102: 67-101.
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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.
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10.	Luo CF, Su B. Analgesic technique for primary colon cancer surgery doesn’t affect cancer recurrence. Anesth Analg , 2010, 14AP8-4.
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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.

《中国循证医学杂志》

全身麻醉复合硬膜外麻醉对肿瘤患者预后影响的Meta分析

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《中国循证医学杂志》

全身麻醉复合硬膜外麻醉对肿瘤患者预后影响的Meta分析

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