摘要
目的系统性回顾区域麻醉(regional anesthesia,RA)对肿瘤患者术后远期生存率的影响。方法检索并筛选Pubmed、Cochrane图书馆和Embase数据库中从建库至2020-09-04关于RA与肿瘤远期预后的随机对照试验(randomized controlled trial,RCT)。通过提取时间-事件数据[风险比(hazard ratio,HR)]计算无复发生存期(relapse free survival,RFS)和总生存期(overall survival,OS)的合并效应量。结果本研究纳入8个RCT共3337例患者。与全身麻醉(general anesthesia,GA)相比,RA对RFS(HR,-0.07;95%CI,-0.22~0.08)、OS(HR,0.05;95%CI,-0.2~0.11)、肿瘤进展时间(time to tumor progress,TTP)(HR,0.03;95%CI,-0.36~0.41)、5年RFS[相对危险度(relative risk,RR),1.26;95%CI,0.66~2.4]和5年OS(RR,1.19;95%CI,0.73~1.96)无影响。基于研究设计、患者特征和肿瘤类型的亚组分析也表明RA对RFS和OS没有影响。结论没有明显的证据支持RA能够改善肿瘤患者术后的远期生存。
Objective To study the effect of regional anesthesia(RA)on long-term survival of cancer patients.Methods Pubmed,Cochrane Library and Embase were searched for randomized controlled trails(RCTs)published from inception to September 4,2020,in which RA was initiated perioperatively.The time-to-event data(hazard ratio(HR))was retrieved independently and in duplicate.Pooled estimates of recurrence-free survival(RFS)and overall survival(OS)were calculated.Results Eight RCTs involving 3337 participants were included.Compared with general anesthesia(GA),RA had no effect on RFS(-0.07,95%CI,-0.22 to 0.08)(GRADE A),OS(0.05,95%CI,-0.2 to 0.11)(GRADE A),time to tumor progression(0.03,95%CI,-0.36 to 0.41)(GRADE C),five-year RFS(risk ratio(RR),1.26,95%CI,0.66 to 2.4)(GRADE C)or 5-year OS(RR,1.19,95%CI,0.73 to 1.96)(GRADE C).Subgroup analysis based on study design,patient characteristics and tumor types also showed no effect of RA on RFS or OS.Conclusions There is no significant evidence supporting the role of RA in improving long-term survival after oncology surgery.
作者
张捍平
刘华
江婧
蔡宇璐
ZHANG Hanping;LIU Hua;JIANG Jing;CAI Yulu(Department of Anesthesiology,Jiangsu Provincial Corps Hospital,Chinese People’s Armed Police Force,Yangzhou 225003,China;Department of Characteristic Speciality,Jiangsu Provincial Corps Hospital,Chinese People’s Armed Police Force,Yangzhou 225003,China)
出处
《武警医学》
CAS
2021年第7期590-594,599,共6页
Medical Journal of the Chinese People's Armed Police Force
关键词
区域麻醉
全身麻醉
肿瘤
复发
生存
regional anesthesia
general anesthesia
tumor
recurrence
survival
