Postoperative Long-Term Outcomes and Independent Risk Factors of Non-Small-Cell Lung Cancer Patients With Propofol versus Sevoflurane Anesthesia: A Retrospective Cohort Study

Abstract

Background: Existing studies have shown that the relationship between anesthetic agents and non-small-cell lung cancer (NSCLC) prognosis remains controversial. Therefore, this retrospective cohort study was designed to investigate the effects of propofol or sevoflurane anesthesia on the long-term oncologic outcomes of NSCLC patients.Methods: We identified 1,778 eligible patients (propofol-based total intravenous anesthesia (TIVA) group, n = 686; sevoflurane-based inhalation anesthesia (INHA) group, n = 1,092) out of 2,388 patients undergoing elective NSCLC surgery from June 2013 to June 2016 in the Harbin Medical University Cancer Hospital. The primary endpoints were five-year overall survival and recurrence-free survival. The secondary endpoints were independent risk factors of cancer recurrence or all-cause mortality. The data were analyzed with propensity score matching, Kaplan–Meier survival, and Cox multivariate analyses as appropriate.Results: After propensity score matching, there were 672 patients in each group. The median follow-up period was 69 months (interquartile range: 68–70 months) for all patients. Five-year overall survival was 75.7% (95% confidence interval (CI) 72.4–79.1) in the TIVA group and 71.8% (68.4–75.4) in the INHA group (p = 0.160) (hazard ratio (HR), 0.86; 95% CI, 0.70–1.06; p = 0.158), and five-year recurrence-free survival was 68.5% (65.0–72.2) and 62.7% (59.1–66.5 (p = 0.108) (HR, 0.90; 95% CI, 0.75–1.08; p = 0.253), respectively. Subgroup analyses showed there were no significant difference in the overall survival or recurrence-free survival between the two groups in each TNM stage of NSCLC. The independent risk factors included age ≥60 years, male, blood transfusion, segmental/wedge resection and pneumonectomy, thoracotomy, postoperative complications, lung adenocarcinoma, TNM stages, high CEA and CYFRA211 levels, and postoperative radiotherapy.Conclusions: Our data indicated no difference between the propofol-based TIVA and sevoflurane-based INHA in terms of five-year overall survival and recurrence-free survival after NSCLC surgery.

Lung and blood perioperative metalloproteinases in patients undergoing oncologic lung surgery: Prognostic implications

“…Two large retrospective studies studied the relevance of the anesthetic technique on mortality and oncologic recurrence in patients operated on for lung cancer and have offered disparate results 28,29 . We found no differences in these two prognostic variables in patients who received sevoflurane or propofol.…”

Effects of anesthesia on long-term survival in cancer surgery: A systematic review and meta-analysis

“…Forty-two retrospective cohort studies and two RCTs with a total of 686,923 patients were included in this study [ [19] , [20] , [21] , [22] , [23] , [24] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] ]. Thirty-five trials were single-center studies [ 19 , [21] , [22] , [23] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [50] , [51] , …”

“…Types of cancer surgery and inhalation anesthetics varied between studies. In total, two studies enrolled participants undergoing surgery for glioblastoma [ 47 , 56 ], one study for oral cancer [ 63 ], nine studies for breast cancer [ 34 , 37 , 42 , 45 , 49 , 53 , 59 , 61 , 71 ], five studies for non-small cell lung cancer [ 38 , 55 , 60 , 65 , 69 ], two studies for esophageal cancer [ 36 , 68 ], four studies for gastric cancer [ 40 , 44 , 50 , 57 ], five studies for colorectal cancer [ 34 , 39 , 48 , 54 , 62 ], four studies for hepatobiliary cancer [ 19 , 41 , 43 , 51 ], two studies for pancreatic cancer [ 52 , 64 ], two studies for gynecological cancer [ 21 , 22 ], two studies for urological cancer [ 23 , 58 ], one study for osteosarcoma [ 66 ], and six studies for various cancers [ 20 , 24 , 35 , 46 , 68 , 70 ]. For inhalation anesthetics, seventeen studies used sevoflurane to maintain anesthesia [ 19 , 21 , 34 , 38 , 40 , [47] , [48] , [49] , 53 , 59 , [62] , [63] , [64] , …”

Effect of Sevoflurane on the Proliferation of A549 Lung Cancer Cells

“…Further research is needed to better understand the potential implications of sevoflurane exposure on lung cancer development and progression. A clinical study published in 2022, which retrospectively analyzed more than 1500 lung cancer surgeries, also proved that there was no difference in the long-term prognosis of lung cancer between propofol-based TIVA and sevoflurane-based inhalation anesthesia [ 37 ].…”