麻醉技术对接受胆囊癌手术的患者抗肿瘤免疫的影响：一项前瞻性随机比较研究
Effect of anesthetic technique on antitumor immunity in patients undergoing surgery for gall bladder cancer: A prospective randomized comparative study
影响因子:4.70000
分区:医学2区 / 肿瘤学2区
发表日期:2025 Jan 15
作者:
Ankit Sharma, Lata Kumari, Brajesh Kumar Ratre, Maroof Ahmad Khan, Sunil Kumar, Rakesh Kumar Deepak, Vinod Kumar, Nishkarsh Gupta, Rakesh Garg, Seema Mishra, Sushma Bhatnagar, Sachidanand Jee Bharati
摘要
关于麻醉技术对抗肿瘤免疫的影响，尤其是在胆囊恶性肿瘤中，文献缺乏文献。我们设计了一项研究，以比较基于丙泊酚的总静脉麻醉和基于七氟苯二甲酸酯的全身麻醉抗肿瘤免疫的影响，包括肿瘤生长因子-β（TGF-β），T-助细胞谱和炎症标记。在大三级癌症医院的全身麻醉下，在64例接受胆囊恶性肿瘤手术的患者中进行了前瞻性随机试验。 ASA身体状况I-III的成年癌症患者符合纳入标准的患者被随机分为S组（基于Sevoflurane的全身麻醉）或T组（基于丙泊酚的总总麻醉）。获得术前（手术早晨）和术后（手术后24小时和1个月）血液样本。两组之间的人口统计学轮廓和术前参数都是可比的。 TGF-β的术后值（在T组较高）上存在统计学上的显着差异。术后白细胞介素17a值（指示Th17细胞）在统计学上有显着差异，并且在基于S.丙泊酚的TIVA组中发现它更高会增加血清TGF-β水平。同时，Sevoflurane调节基于T-助血细胞的免疫力增加胆囊癌患者的Th17细胞。需要进行多项较大的研究来验证结果并提供有用的建议。
Abstract
There is a paucity of literature regarding the effect of anesthetic techniques on antitumor immunity, especially in gall bladder malignancies. We designed a study to compare the effect of propofol-based total intravenous anesthesia and sevoflurane-based general anesthesia-on antitumor immunity, including tumor growth factor-β (TGF-β), T-helper cell profile, and inflammatory markers. A pilot prospective randomized trial was conducted in 64 patients undergoing surgery for gall bladder malignancy under general anesthesia in a tertiary specialty cancer hospital. Adult cancer patients of ASA physical status I-III fulfilling the inclusion criteria were randomized to either group S (sevoflurane-based general anesthesia) or group T (propofol-based total intravenous anesthesia). Preoperative (morning of surgery) and postoperative (24 h and 1 month after surgery) blood samples were obtained. Demographic profile and preoperative parameters were comparable between both groups. There was a statistically significant difference in the postoperative value of TGF-β (higher in group T). There was a statistically significant difference in postoperative interleukin-17A value (indicative of TH17 cells), and it was found to be higher in group S. Propofol-based TIVA increases serum TGF-β levels. At the same time, Sevoflurane modulates T-helper cells-based immunity to increase TH17 cells in patients with gall bladder cancer. Multiple larger studies will be required to validate the results and provide useful recommendations.