麻醉技术对胆囊癌手术患者抗肿瘤免疫的影响：一项前瞻性随机对照研究
Effect of anesthetic technique on antitumor immunity in patients undergoing surgery for gall bladder cancer: A prospective randomized comparative study
DOI 原文链接
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影响因子:4.7
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
DOI:
10.1002/ijc.35179
摘要
关于麻醉技术对抗肿瘤免疫作用的研究较少，特别是在胆囊恶性肿瘤中。本研究旨在比较丙泊酚全静脉麻醉与七氟烷全身麻醉对抗肿瘤免疫的影响，包括肿瘤生长因子-β（TGF-β）、T辅助细胞谱以及炎症标志物。在一所三级专科癌症医院中，进行了一项64例胆囊恶性肿瘤手术患者的前瞻性随机试验。符合入选标准的成人癌症患者（ASA I-III级）被随机分为S组（七氟烷全身麻醉）或T组（丙泊酚全静脉麻醉）。在术前（手术当天早晨）和术后（术后24小时及1个月）采集血样。两组在基本资料和术前参数方面相当。术后TGF-β水平显著升高（T组更高），而白细胞介素-17A（代表TH17细胞）水平也存在显著差异，且在S组更高。丙泊酚全静脉麻醉增加血清TGF-β水平，而七氟烷则调节T辅助细胞免疫，促使患者体内TH17细胞升高。需要更多大规模研究以验证这些结果，并提供临床建议。
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.