An intravenous anesthetic drug-propofol, influences the biological characteristics of malignant tumors and reshapes the tumor microenvironment: A narrative literature review

Abstract

Malignant tumors are the second leading cause of death worldwide. This is a public health concern that negatively impacts human health and poses a threat to the safety of life. Although there are several treatment approaches for malignant tumors, surgical resection remains the primary and direct treatment for malignant solid tumors. Anesthesia is an integral part of the operation process. Different anesthesia techniques and drugs have different effects on the operation and the postoperative prognosis. Propofol is an intravenous anesthetic that is commonly used in surgery. A substantial number of studies have shown that propofol participates in the pathophysiological process related to malignant tumors and affects the occurrence and development of malignant tumors, including anti-tumor effect, pro-tumor effect, and regulation of drug resistance. Propofol can also reshape the tumor microenvironment, including anti-angiogenesis, regulation of immunity, reduction of inflammation and remodeling of the extracellular matrix. Furthermore, most clinical studies have also indicated that propofol may contribute to a better postoperative outcome in some malignant tumor surgeries. Therefore, the author reviewed the chemical properties, pharmacokinetics, clinical application and limitations, mechanism of influencing the biological characteristics of malignant tumors and reshaping the tumor microenvironment, studies of propofol in animal tumor models and its relationship with postoperative prognosis of propofol in combination with the relevant literature in recent years, to lay a foundation for further study on the correlation between propofol and malignant tumor and provide theoretical guidance for the selection of anesthetics in malignant tumor surgery.

Influence of the Anesthetic Technique on Circulating Extracellular Vesicles in Bladder Cancer Patients Undergoing Radical Cystectomy: A Prospective, Randomized Trial

“…It has already been shown that incubation of colon carcinoma cells with sera from colon carcinoma patients who received Propofol anesthesia increased the apoptosis rate compared to Sevoflurane anesthesia [25], which indicates that serum factors are regulated using anesthetics and these might influence tumor growth, with a particular focus on EVs and associated miRNAs [35]. Propofol was shown to exhibit antitumor effects by regulating different miRNAs and lncRNAs and thus influencing important signaling pathways of carcinogenesis [36]. Moreover, Propofol inhibits proliferation, migration and invasion of bladder carcinoma cells through increased micro-RNA expression in vitro, being in line with our results [24].…”

“…If the choice of anesthesia affects tumor-inhibitory signaling pathways in patients that could prevent the development of metastases and recurrences via EVs and associated miRNAs, this possible therapeutic potential should be exploited and explored further. EVs themselves are already being explored as potential drug delivery vehicles for cancer therapy [48,49] while Propofol is under investigation as a chemosensitizer [36]. If Propofol was demonstrated to result in EV-modulated tumor inhibition in the surgical setting, this would be a simple and desirable way to improve patient outcome.…”

Propofol overcome Tamoxifen resistance in breast cancer by modulating tumorogenesis, immune response and metabolism

“…A large number of studies have demonstrated that in addition to the sedative hypnotic effect, Propofol also affects the development of tumors, reduces the spread of cancer cells by regulating a variety of signaling pathways, and has direct anti-tumor effects[23; 37; 39]. Propofol was also reported that possessed a protective effect on systemic inflammation and immune function[39]. A multi-center retrospective clinical analysis has suggested that Propofol significantly extends survival after surgery for primary breast cancer compared to sevoflurane anesthesia, which may be related to its ability to reduce the function of breast cancer stem cells, induce apoptosis of breast cancer cells, and inhibit the proliferation of breast cancer cells[8].…”