Long-term survival in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: follow-up of a multicentre randomised trial

作者：Shuang-Jie Cao, Yue Zhang, Yuxiu Zhang, Wei Zhao, Linghui Pan, Xude Sun, Zhenyu Jia, Wen Ouyang, Qing-Shan Ye, Fangxiang Zhang, Yongqing Guo, Yanqiu Ai, Bin-Jiang Zhao, Jianbo Yu, Zhiheng Liu, Ning Yin, Xueying Li, Jiahui Ma, Huijuan Li, Meirong Wang, Daniel I. Sessler, Daqing Ma, Dong‐Xin Wang · 发表于：British Journal of Anaesthesia · 年份：2023 · DOI：10.1016/j.bja.2023.01.023 · 被引用次数：46 · 研究领域：Cancer, Stress, Anesthesia, and Immune Response、Anesthesia and Neurotoxicity Research、Nausea and vomiting management

BACKGROUND: Experimental evidence indicates that i.v. anaesthesia might reduce cancer recurrence compared with volatile anaesthesia, but clinical information is observational only. We therefore tested the primary hypothesis that propofol-based anaesthesia improves survival over 3 or more years after potentially curative major cancer surgery. METHODS: This was a long-term follow-up of a multicentre randomised trial in 14 tertiary hospitals in China. We enrolled 1228 patients aged 65-90 yr who were scheduled for major cancer surgery. They were randomised to either propofol-based i.v. anaesthesia or to sevoflurane-based inhalational anaesthesia. The primary endpoint was overall survival after surgery. Secondary endpoints included recurrence-free and event-free survival. RESULTS: Amongst subjects randomised, 1195 (mean age 72 yr; 773 [65%] male) were included in the modified intention-to-treat analysis. At the end of follow-up (median 43 months), there were 188 deaths amongst 598 patients (31%) assigned to propofol-based anaesthesia compared with 175 deaths amongst 597 patients (29%) assigned to sevoflurane-based anaesthesia; adjusted hazard ratio 1.02; 95% confidence interval (CI): 0.83-1.26; P=0.834. Recurrence-free survival was 223/598 (37%) in patients given propofol anaesthesia vs 206/597 (35%) given sevoflurane anaesthesia; adjusted hazard ratio 1.07; 95% CI: 0.89-1.30; P=0.465. Event-free survival was 294/598 (49%) in patients given propofol anaesthesia vs 274/597 (46%) gi...