| Objective:The main purpose of this experiment is to assess whether there is a difference in postoperative cancer recurrence rate in breast cancer patients who receive total intravenous anesthesia and intravenous inhalation combined anesthesia.The secondary purpose is to use multivariate Cox regression analysis to determine the impact of postoperative breast cancer recurrence Potential risk factors,strive to provide the best anesthesia program for breast cancer patients during the perioperative period,reduce the recurrence rate of breast cancer patients after surgery,and improve the prognosis and survival rate of patients.Methods:Approved by the The Sceond Hospital Of Dalian Medical University Ethics Committee,this experiment reviewed the electronic medical records of patients undergoing breast cancer surgery at The Sceond Hospital Of Dalian Medical University from January 2014 to December 2016.According to the literature,the recurrence rate of breast cancer patients is about 10%.The enrollment time of the two groups in this experiment was 36 months,and the follow-up time was 36 months.Set two-sided α=0.05;β= 0.15,the degree of grasp is 85%.Calculated by PASS 11 software,644 cases were required for the intravenous anesthesia group,and 644 samples were required for the intravenous inhalation combined anesthesia group,for a total of 1288 cases.Patients meeting the following criteria were included in the study: 1.Age <65 years old;2.ASA(American Standards Association,National Anesthesiologists Association)classification I-III;3.Primary breast cancer;4.Pathological type of breast cancer is invasive catheter cancer.A total of 1308 patients were enrolled in the study.Using a control method,the patients were divided into a total intravenous anesthesia group(n =655)and intravenous inhalation combined anesthesia group(n = 653)according to the choice of anesthesia method.The independent sample t test was used to compare the difference between the two groups of measurement data,and the χ2 test was used to compare the difference between the two groups of count data.A Kaplan–Meier survival curve was drawn to assess the association between the type of anesthesia before adjusting for confounding factors and the recurrence-free survival rate of breast cancer patients.The Cox regression model was used to compare risk ratios,assess the association between anesthesia type and recurrence-free survival after adjusting for confounding factors,and determine the risk factors for breast cancer recurrence(including anesthesia type).Results:1.Among the 1308 breast cancer surgery patients during the study period,the basic characteristics of the two groups of patients included age,BMI index(Body Mass Index),ASA grade,TNM stage of breast cancer,preoperative chemotherapy,postoperative adjuvant chemotherapy,radiotherapy and endocrine therapy,hormone receptor expression,operation type,operation time,and intraoperative vascular active drug usage had no significant difference(P> 0.05).2.Kaplan–Meier survival curve showed no significant difference in postoperative recurrence-free survival rate between two groups of breast cancer patients(P = 0.716).36(6%)of the 655 patients in the total intravenous anesthesia group relapsed,while in the intravenous inhalation combined anesthesia group of the 653 patients,39(6%)relapsed.Among the 75 relapsed patients,the median relapse-free survival period for patients receiving total intravenous anesthesia was 18(12-25),and the median relapse-free survival period for patients receiving intravenous inhalation combinedanesthesia was 20(14-26).3.The results of the Cox proportional hazard model of relapse-free survival suggest that there is no significant correlation between the intravenous inhalation combined anesthesia group and the lower postoperative recurrence-free survival rate of breast cancer after the total intravenous anesthesia group(HR 1.131;95%CI,0.714-1.789;P=0.600).4.There was no significant difference in the recurrence rate of breast cancer between the total intravenous anesthesia group and the intravenous inhalation combined anesthesia in the first postoperative year,the second postoperative year,and the third postoperative year(P> 0.05).5.Through Cox regression analysis of the cohort,we can also determine the risk factors of cancer recurrence.It is believed that late TNM staging and negative hormone receptors are associated with a high risk of breast cancer recurrence.Conclusion: There is no difference in the effect of total intravenous anesthesia and intravenous inhalation combined anesthesia on tumor recurrence and metastasis in breast cancer patients within 3 years after surgery. |
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