Potential Influence of Anesthetic Interventions on Breast Cancer Early Recurrence According to Estrogen Receptor Expression: A Sub-Study of a Randomized Trial

Mohan Li, Yuelun Zhang, Lijian Pei, Zhiyong Zhang, Gang Tan, Yuguang Huang, Mohan Li, Yuelun Zhang, Lijian Pei, Zhiyong Zhang, Gang Tan, Yuguang Huang

Abstract

Background: Effects of anesthetic interventions on cancer prognosis remain controversial. There is evidence that estrogen receptor (ER)-negative breast cancer patients have an early recurrence peak. We aimed to assess the potential benefit of regional anesthesia-analgesia versus general anesthesia regarding early recurrence in breast cancer according to ER expression.

Methods: Based on a multicenter randomized controlled trial (clinicaltrials.gov, NCT00418457), we included all the patients from Peking Union Medical College Hospital research center in this study. The primary outcome was breast cancer recurrence after surgery. The Cox proportional hazard model was used to compare recurrence between groups.

Results: In total, 1,253 breast cancer patients were included in this sub-study, among whom the median follow-up time was 53 months. In this sub-study, 320 patients were ER-negative, and 933 were ER-positive. As for ER-negative patients, the recurrence risk in the PPA (paravertebral blocks and propofol general anesthesia) group showed no statistical difference compared with the GA (sevoflurane and opioids general anesthesia) group (19.1% versus 23.4%; adjusted HR: 0.80, 95% CI: 0.50-1.30; P = 0.377). In the first 18 months after breast cancer surgery, which is considered as the classical early peak of recurrence, after adjustment for menstruation and the pathological stage of tumor, the decrease of early recurrence observed in the PPA group was not significant compared with the GA group (adjusted HR: 0.63, 95% CI: 0.34-1.14; P = 0.127).

Conclusions: In our study, the effects of early recurrence after breast cancer surgery in both ER-negative and ER-positive patients were similar between regional anesthesia-analgesia and general anesthesia. Large samples of ER-negative patients will be needed to clarify the effects of anesthetic interventions.

Keywords: anesthesia; breast cancer; estrogen receptor; propofol; recurrence.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Li, Zhang, Pei, Zhang, Tan and Huang.

Figures

Figure 1
Figure 1
Hazard rate per 6 months in ER-negative patients and ER-positive patients.
Figure 2
Figure 2
Recurrence curve and hazard rate per 6 months among patients who were given PPA or GA. Recurrence curve in all patients (A), ER-negative patients (B), and ER-positive patients (C). Hazard rate per 6 months in all patients (D), ER-negative patients (E), and ER-positive patients (F). ER, estrogen receptor; PPA, paravertebral block with propofol general anesthesia; GA, fentanyl with sevoflurane general anesthesia; HR, hazard ratio; CI, confidence interval. HR, 95% CI and P values were reported using adjusted multivariable Cox regression Model 1 adjusted for menstruation and pathology stage of tumor (binary).

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