Effect of Propofol and Desflurane on Nucleic Acid of Liver Circulating Tumor

August 15, 2022 updated by: Fang Jun, Zhejiang Cancer Hospital
To investigate the effects of perioperative anesthetic drugs propofol and desflurane on circulating tumor nucleic acids (CK7, ELF3, EGFR and EphB4 mRNA) in the blood of patients with liver cancer, so as to provide scientific reference for clinical anesthesia in the perioperative treatment of tumor

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Hepatocellular carcinoma (HCC) is one of the most malignant tumors in oncology. Its incidence is increasing, and there is a lack of reliable biomarkers for early diagnosis, prognosis evaluation and efficacy evaluation. There is a pool of tumor molecules derived from primary tumors in the blood circulation, including Circulating tumor proteins, Circulating tumor cells (CTCs), Extracellular vesicles, Evs, Tumor "educated" platelets (TEPs), and Circulating Tumor nucleic acids, known as Circulating Tumor DNA, CtDNA is a Circulating cell-free DNA (ccfDNA). Liquid biopsy is performed to detect tumor molecules from blood circulation. Small RNA (miRNA) and long noncoding RNA (miRNA) in liquid biopsy are detected. Circulating tumor RNA (ctRNA), such as lncRNA, can be used as epigenetic biomarkers to improve the early diagnosis of HCC and to treat patients with early and advanced HCC. Propofol and desflurane, as important anesthesia drugs in perioperative period, have been shown to affect the concentration of circulating nucleic acid in patients. Furong Song found that propofol could inhibit the overexpression of HOXA11-AS, which reversed the inhibitory effect of propofol treatment on HCC cell progression, by promoting the expression of Mir-4458, and had an impact on HCC cell progression . However, Dongmei Wang and their colleagues found that circulating H19 inhibited the effect of propofol in promoting HCC cell apoptosis by upregulating LIMK1 (LIM domain kinase 1) through spongy Mir-520a-3p . Meanwhile, Buschmann and his team found that propofol and desflurane inhibited key cancer-related pathways such as proliferation and migration in colorectal cancer, and found that propofol did not affect the size distribution and protein labeling of circulating vesicles, but could reduce their concentration . Compared with inhaled anesthetics, Bon-Wook Koo found that HCC patients treated with propofol had a lower recurrence rate and a longer average recurrence time than those treated with inhaled anesthetics . Hou-chuan Lai found that compared with desflurane anesthesia regimen, propofol anesthesia regimen significantly improved the survival rate of patients with liver cancer without distant metastasis or local recurrence . Meanwhile, Frederique Hovaguimian found that in nonmetastatic and metastatic breast cancer, the maximum number of circulating tumor cells increased by 36% after sevoflurane inhalation anesthesia and was independently associated with a higher risk of disease recurrence and reduced survival . At this time, the monitoring of circulating tumor cells can represent promising methods, such as the detection of suitable markers of circulating tumor cells, such as Cytokeratin 7 (CK7), E74-like factor 3 (ELF3), Epidermal growth factor receptor (EGFR) and Peripheral blood mononuclear cells, The expression of erythropoietin-producing hepatocellular carcinoma receptor B4 (EphB4) mRNA in PMBCs, In order to better understand the effect of anesthesia on perioperative tumor treatment, this evidence has been supported by domestic and foreign studies . Soo-ho Lee and his colleagues found that CK7-negative liver cancer patients had a higher survival rate than all positive patients [9], which was supported by Xialing Huang and his team . Longbo Zheng found that ELF3 inhibits ZE1 by inhibiting Mir-141-3p, thereby inhibiting E-cadherin in HCC cells and promoting EMT, which is a potential prognostic biomarker and/or therapeutic target for HCC . Zhe Wu found that lncrNA-UBE2R2-AS1 in HCC shows carcinogenic effect through the up-regulation of EGFR by Mir-302b, and can be used as a potential therapeutic target and prognostic biomarker for HCC patients , and this mechanism of action was confirmed by Zhen-Jiang Ma and his research . At the same time, it was found that the expression level of EphB4 was increased in HCC tumor tissues, and the levels of EphB4 and P-JAK2 were positively correlated in samples of HCC patients , while the expression of CIRC-EPHB4 was down-regulated. Circ-ephb4 overexpression inhibited the viability of HCC cells, induced apoptosis, and inhibited cell migration and invasion by inhibiting the expression of hypoxia-inducible factor-1α (HIF-1α) . However, the perioperative effects and molecular mechanisms of propofol and desflurane on circulating tumor nucleic acids in liver cancer are not very clear at present, and further relevant studies are needed to clarify, so as to provide support and guidance for the development of perioperative anesthesia plan and clinical diagnosis of liver cancer.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
60

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • China
    • Zhejiang
      • Hangzhou, Zhejiang, China, 310022
        • Zhejiang Cancer Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

14 years to 71 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Age range: 18 to 75
  • ASA: I-III
  • primary liver cancer (CNLC: Stage I-IIIA)
  • undergoing elective hepatectomy

Exclusion Criteria:

  • Patients with severe bradycardia (HR < 55bpm)
  • patients with severe arrhythmias or cardiac dysfunction (EF < 35%)
  • patients with severe respiratory lung disease
  • patients with severe liver and kidney insufficiency epilepsy
  • patients with severe hyperlipidemia
  • patients with a history of malignant hyperthermia
  • patients with propofol or desflurane allergy
  • patients with history of preoperative chemoradiotherapy
  • patients who were on immunosuppressive treatment
  • patients with chronic opioid therapy declined to participate in the study

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Active Comparator: propofol
propofol（50ml,1g）,Intravenous propofol infusion was slowly pushed until loss of consciousness, and anesthesia was maintained at 4-8 mg/kg/h
Drug: Propofol
Propofol general anesthesia group (P group) : intravenous propofol infusion was slowly pushed until consciousness disappeared, and then anesthesia was maintained at 4-8 mg/kg/h.
Other Names:
  • group P
Active Comparator: desflurane
In the general anesthesia group with desflurane( 240ml), intravenous propofol infusion was slowly pushed until consciousness disappeared, and then anesthesia was maintained with 4-6% desflurane
Drug: Desflurane
Propofol general anesthesia group (P group) : intravenous propofol infusion was slowly pushed until consciousness disappeared, and then anesthesia was maintained at 4-8 mg/kg/h. In the general anesthesia group with desflurane (group D), intravenous propofol infusion was slowly pushed until consciousness disappeared, and then anesthesia was maintained with 4-6% desflurane. The analgesic and muscle relaxant regimens were the same in both groups except for sedative drugs. All patients were treated with no medication before operation, and the operation was completed under endotracheal intubation and general anesthesia. The amount of propofol or desflurane was adjusted according to BIS or MAC values and hemodynamic changes during operation. Add 10mg of rocuronium every half hour. Vasoactive drugs can be used to maintain hemodynamic stability during the operation, and corresponding records should be made
Other Names:
  • group D

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
The changes of circulating tumor nucleic acids (CK7, ELF3, EGFR and EphB4 mRNA) in peripheral blood of patients with hepatocellular carcinoma after perioperative treatment with propofol and desflurane
Time Frame: Immediately Before induction of anesthesia, Immediately before skinning after induction of anesthesia, during operation, PACU at the end of operation, and on the 7th day after operation
Circulating tumor nucleic acid (CK7, ELF3, EGFR, and EphB4 mRNA) concentrations were determined by real-time RT-PCR in Applied Biosystems 7500 (Foster City, CA, USA) using SYBR® Premix Ex TaqTM II (Po, Otsu, Japan). Sequence of primers designed as previously described. Total mRNA was normalized to GAPDH and relative mRNA expression of the sample by calculating 2- δδCT, and differential expression of the sample was defined as upregulation when the cutoff value was set to 2x
Immediately Before induction of anesthesia, Immediately before skinning after induction of anesthesia, during operation, PACU at the end of operation, and on the 7th day after operation

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Zhejiang Cancer Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
December 1, 2020

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
August 8, 2022

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
August 8, 2022

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
August 9, 2022

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 15, 2022

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
August 16, 2022

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
August 16, 2022

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 15, 2022

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
August 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 2020-09-01

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

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