Jia Dong1, Min Zeng1, Nan Ji2, Shuyu Hao2, Yang Zhou1, Zhixian Gao2, Hongqiu Gu3, Li Zhang4, Daqing Ma5, Yuming Peng1, Ruquan Han1. 1. Departments of Anesthesiology. 2. Neurosurgery. 3. Neurology, Tiantan Clinical Trial and Research Centre for Stroke, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China. 4. Division of Hematology and Medical Oncology, Department of Medicine; Department of Epidemiology and Biostatistics University of California, San Francisco, CA. 5. Department of Surgery and Cancer, Pain Medicine and Intensive Care, Imperial College London, Chelsea and Westminster Hospital, London, UK.
Abstract
BACKGROUND: Intravenous and inhalational anesthesia might have different associations with long-term outcome in cancer patients, with reports of adverse effects of inhalation anesthesia. However, the effects of anesthesia in patients with high-grade glioma (HGG) are not known. METHODS: This study investigated 154 patients who received propofol and 140 patients who received sevoflurane for maintenance of anesthesia during HGG tumor resection. The primary outcomes were progression-free survival and overall survival. RESULTS: Median progression-free survival was 10 months (interquartile range [IQR], 6 to 18) versus 11 months (IQR 6 to 20; P=0.674), and median overall survival was 18 months (IQR, 11 to 39) versus 18 months (IQR, 10 to 44; P=0.759) in patients maintained with propofol and sevoflurane, respectively. Higher preoperative Karnofsky performance status and postoperative chemotherapy were associated with a reduced hazard of tumor progression or death, whereas higher age-adjusted Charlson comorbidity index and longer duration of anesthesia were associated with an increased hazard of progression or death. World Health Organization tumor classification IV and incomplete tumor resection were associated with an increased hazard of tumor progression but not death. Anesthesia maintenance with sevoflurane increased the risk of death in patients with Karnofsky performance status <80 compared with propofol (hazard ratio, 1.66; 95% confidence interval, 1.08-2.57; P=0.022). CONCLUSIONS: Compared with maintenance of anesthesia with propofol, sevoflurane did not worsen progression-free or overall survival in patients with HGG undergoing tumor resection. However, propofol might be beneficial in patients with poor preoperative Karnofsky performance status.
BACKGROUND: Intravenous and inhalational anesthesia might have different associations with long-term outcome in cancerpatients, with reports of adverse effects of inhalation anesthesia. However, the effects of anesthesia in patients with high-grade glioma (HGG) are not known. METHODS: This study investigated 154 patients who received propofol and 140 patients who received sevoflurane for maintenance of anesthesia during HGG tumor resection. The primary outcomes were progression-free survival and overall survival. RESULTS: Median progression-free survival was 10 months (interquartile range [IQR], 6 to 18) versus 11 months (IQR 6 to 20; P=0.674), and median overall survival was 18 months (IQR, 11 to 39) versus 18 months (IQR, 10 to 44; P=0.759) in patients maintained with propofol and sevoflurane, respectively. Higher preoperative Karnofsky performance status and postoperative chemotherapy were associated with a reduced hazard of tumor progression or death, whereas higher age-adjusted Charlson comorbidity index and longer duration of anesthesia were associated with an increased hazard of progression or death. World Health Organization tumor classification IV and incomplete tumor resection were associated with an increased hazard of tumor progression but not death. Anesthesia maintenance with sevoflurane increased the risk of death in patients with Karnofsky performance status <80 compared with propofol (hazard ratio, 1.66; 95% confidence interval, 1.08-2.57; P=0.022). CONCLUSIONS: Compared with maintenance of anesthesia with propofol, sevoflurane did not worsen progression-free or overall survival in patients with HGG undergoing tumor resection. However, propofol might be beneficial in patients with poor preoperative Karnofsky performance status.
Authors: Stefan J Grau; Mario Löhr; Valeria Taurisano; Herbert Trautner; Marco Timmer; Stephanie G Schwab; Jürgen Hampl; Thorsten Annecke Journal: Sci Rep Date: 2020-03-27 Impact factor: 4.379
Authors: Thomas Schmoch; Christine Jungk; Thomas Bruckner; Sabine Haag; Klaus Zweckberger; Andreas von Deimling; Thorsten Brenner; Andreas Unterberg; Markus A Weigand; Florian Uhle; Christel Herold-Mende Journal: Neurosurg Rev Date: 2020-12-22 Impact factor: 3.042