Newly Published
Perioperative Medicine  |   June 2020
Anesthesia and Circulating Tumor Cells in Primary Breast Cancer Patients: A Randomized Controlled Trial
Author Notes
  • From the Institute of Anesthesiology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland (F.H., M.S., B.B.-S.); the Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health (F.H.), the Epidemiology, Biostatistics and Prevention Institute, Department of Epidemiology (J.B., M.A.P.), the Institute of Physiology and Zurich Center for Integrative Human Physiology (B.R.Z., M.S., B.B.-S.), and the Cytometry Facility (C.D., C.E.), University of Zurich, Zurich, Switzerland; the Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland (K.J.D., D.F.); the Institute of Anesthesiology, Hirslanden Clinic Zurich, Zurich, Switzerland (U.R., M.S.); the Faculty of Medicine, University of Basel, Basel, Switzerland (M.S.); the Department of Surgery (C.T.) and the Clinical Trial Unit (B.P.), Breast Center Zurich, Zurich, Switzerland; and the Department of Anesthesiology, University of Illinois College of Medicine at Chicago, Chicago, Illinois (B.B.-S.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site.
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site.×
  • Submitted for publication October 25, 2019. Accepted for publication May 12, 2020.
    Submitted for publication October 25, 2019. Accepted for publication May 12, 2020.×
  • Part of the work presented in this article has been presented as abstract A2182 at the American Society of Anesthesiologists Annual Meeting in Chicago, Illinois, October 24, 2016.
    Part of the work presented in this article has been presented as abstract A2182 at the American Society of Anesthesiologists Annual Meeting in Chicago, Illinois, October 24, 2016.×
  • Correspondence: Address correspondence to Dr. Beck-Schimmer: University Hospital and University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. beatrice.beckschimmer@uzh.ch. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Pharmacology
Perioperative Medicine   |   June 2020
Anesthesia and Circulating Tumor Cells in Primary Breast Cancer Patients: A Randomized Controlled Trial
Anesthesiology Newly Published on June 17, 2020. doi:https://doi.org/10.1097/ALN.0000000000003409
Anesthesiology Newly Published on June 17, 2020. doi:https://doi.org/10.1097/ALN.0000000000003409
Abstract

Background: The effect of anesthetic drugs on cancer outcomes remains unclear. This trial aimed to assess postoperative circulating tumor cell counts—an independent prognostic factor for breast cancer—to determine how anesthesia may indirectly affect prognosis. It was hypothesized that patients receiving sevoflurane would have higher postoperative tumor cell counts.

Methods: The parallel, randomized controlled trial was conducted in two centers in Switzerland. Patients aged 18 to 85 yr without metastases and scheduled for primary breast cancer surgery were eligible. The patients were randomly assigned to either sevoflurane or propofol anesthesia. The patients and outcome assessors were blinded. The primary outcome was circulating tumor cell counts over time, assessed at three time points postoperatively (0, 48, and 72 h) by the CellSearch assay. Secondary outcomes included maximal circulating tumor cells value, positivity (cutoff: at least 1 and at least 5 tumor cells/7.5 ml blood), and the association between natural killer cell activity and tumor cell counts. This trial was registered with ClinicalTrials.gov (NCT02005770).

Results: Between March 2014 and April 2018, 210 participants were enrolled, assigned to sevoflurane (n = 107) or propofol (n = 103) anesthesia, and eventually included in the analysis. Anesthesia type did not affect circulating tumor cell counts over time (median circulating tumor cell count [interquartile range]; for propofol: 1 [0 to 4] at 0 h, 1 [0 to 2] at 48 h, and 0 [0 to 1] at 72 h; and for sevoflurane: 1 [0 to 4] at 0 h, 0 [0 to 2] at 48 h, and 1 [0 to 2] at 72 h; rate ratio, 1.27 [95% CI, 0.95 to 1.71]; P = 0.103) or positivity. In one secondary analysis, administrating sevoflurane led to a significant increase in maximal tumor cell counts postoperatively. There was no association between natural killer cell activity and circulating tumor cell counts.

Conclusions: In this randomized controlled trial investigating the effect of anesthesia on an independent prognostic factor for breast cancer, there was no difference between sevoflurane and propofol with respect to circulating tumor cell counts over time.

Editor’s Perspective:

What We Already Know about This Topic:

  • Anesthesia may contribute to the distant spread of cancer during surgical treatment

  • The presence of circulating tumor cells has been independently associated with both a higher risk of disease recurrence and reduced survival in both nonmetastatic and metastatic breast cancer

What This Article Tells Us That Is New:

  • The hypothesis that postoperative circulating tumor cell counts would be higher in primary breast cancer patients receiving sevoflurane anesthesia than in those receiving intravenous anesthesia with propofol was tested in a randomized controlled trial of 210 patients

  • The type of anesthesia did not affect circulating tumor cell counts over time (median circulating tumor cell count/7.5 ml blood [interquartile range]: for propofol, 1 [0 to 4] at end of surgery (0 h), 1 [0 to 2] at 48 h, and 0 [0 to 1] at 72 h; and for sevoflurane, 1 [0 to 4] at 0 h, 0 [0 to 2] at 48 h, and 1 [0 to 2] at 72 h; rate ratio, 1.27 [95% CI, 0.95 to 1.71])