Effects of anesthetic technique and surgery on myeloid-derived suppressor cells and prognosis in women who underwent breast cancer surgery: a prospective study

Figures & data

Table 1 Comparison of clinical characteristics of the SEV and TIVA groups

	SEV (%)	TIVA (%)	X^2	P-value
No. of patients	38	42	—	—
Age (year)	51.0 (43.5–62.0)	49.0 (42.3–53.3)	—	0.196*
Height (cm)	161.0 (160.0–165.0)	163.0 (160.0–165.3)	—	0.115*
Weight (kg)	58.0 (52.8–60.5)	58.0 (56.8–59.3)	—	0.507*
ASA			1.973	0.373^†
I	20 (52.6)	28 (66.7)
II	14 (36.8)	12 (28.6)
III	4 (10.5)	2 (4.8)
Duration of anesthesia (mins)	80.0 (55.0–120.0)	70.0 (60.0–100.0)	—	0.768*
Tumor size (cm)	2.0 (1.5–2.6)	2.0 (1.2–3.1)	—	0.836*
Carcinoma cell embolus (+)	10 (26.3)	14 (33.3)	0.468	0.494^†
Nerve invasion (+)	4 (10.5)	6 (14.3)	0.029	0.866^†
ER (+)	31(81.6)	28(66.7)	2.292	0.130^†
PR (+)	30 (78.9)	27 (64.3)	2.094	0.148^†
HER-2 expression	8 (21.1)	9 (21.4)	0.002	0.967^†
Surgical approach			0.551	0.908^†
BCS	15 (39.5)	16 (38.1)
Mastectomy	23 (60.5)	26 (61.9)
Perioperative bleeding (mL)	100 (57.5–200)	100 (67.5–150)	—	0.316*
Time of surgery (mins)	80 (55–120)	70 (60–100)	—	0.768*
Pathology grade			2.866	0.413^†
0	0 (0)	1 (2.4)
I	3 (7.9)	5 (11.9)
II	20 (52.6)	25 (59.5)
III	15 (39.5)	11 (26.2)
TNM staging			3.093	0.378^†
Tis	1 (2.6)	2 (4.8)
Stage I	12 (31.6)	14 (33.3)
Stage II	19 (50.0)	14 (33.3)
Stage III	6 (15.8)	12 (28.6)
Adjuvant therapy
Chemotherapy	31 (81.6)	32 (76.2)	0.346	0.556^†
Hormonal therapy	31 (81.6)	28 (66.7)	2.292	0.130^†
Targeted therapy	8 (21.2)	9 (21.4)	0.002	0.967^†
Radiotherapy	15 (39.5)	20 (47.6)	0.538	0.463^†

Notes: All data are presented as No. (%) or median (25–75% interquartile range). *Mann–Whitney test. ^†Chi-square (X²) test. TNM staging was defined by NCCN guideline Version 1.0 (2018).

Abbreviations: ASA, American Society of Anesthesiologists; SEV, sevoflurane-based anesthetic; TIVA, total intravenous anesthetic; NCCN, National Comprehensive Cancer Network; BCS, breast-conserving surgery; ER, estrogen receptor; PR, progesterone-receptor HER-2: human epidermal growth factor receptor 2.

Figure 1 CONSORT flow diagram.

Abbreviations: BCS, breast-conserving surgery; SEV, sevoflurane-based anesthetic; TIVA, total intravenous anesthetic.

Table 2 Analgesia and adverse reactions and in the SEV and TIVA groups

	SEV (n=38)	TIVA (n=42)	X^2	P-value
Intraoperative opioid
Remifentanil	0 (0)	60 (100)	120.000	0.000^†
Fentanyl	42 (70.0)	42 (70.0)
Postoperative analgesia Fentanyl	6 (10.0)	4 (6.7)	0.436	0.509^†
Flurbiprofen axetil (50 mg)
Flurbiprofen axetil (100 mg)	14 (23.4)	11 (18.4)	0.455	0.500^†
Postoperative VAS
VAS for 2 hrs	2 (1–2)	2 (1–2)	—	0.393*
VAS for 24 hrs	2 (1–3)	2 (2–3.5)	—	0.194*
Adverse reactions
Sedation	2 (5.3)	3 (7.1)	0.000	1.000*
Nausea and vomiting	3 (7.9)	1 (2.4)	0.380	0.538*
Dysphoria	1 (2.6)	0 (0)	0.003	0.960*

Notes: All data are presented as No. (%) or median (25–75% interquartile range). *Mann–Whitney test. ^†Chi-square (X²) test.

Abbreviations: SEV, sevoflurane-based anesthetic; TIVA,total intravenous anesthetic.

Figure 2 Expression of postoperative circulating myeloid-derived suppressor cells (MDSCs) in the two anesthetic groups (P=0.202).

Abbreviations: SEV, sevoflurane-based anesthetic; TIVA, total intravenous anesthetic.

Table 3 Comparison of perioperative factors in different surgical methods

	Mastectomy	BCS	X^2	P-value
No. of patients	49	31	—	—
Anesthetic method			0.016	0.899^†
SEV	23 (46.9)	15 (48.4)
TIVA	26 (53.1)	16 (51.6)
Intraoperation opioids
Remifentanil	26 (53.1)	16 (51.6)	0.016	0.899^†
Fentanyl	36 (73.5)	24 (77.4)	0.158	0.691^†
Postoperative analgesia
Fentanyl	2 (4.1)	4 (12.9)	1.048	0.306^†
Flurbiprofen axetil (50mg)	49 (100)	31 (100)	—	—
Flurbiprofen axetil (100mg)	7 (14.3)	8 (25.8)	1.654	0.198^†
Serological indices
Preoperative MDSCs (%)	1.02 (0.67–2.17)	1.25 (1.02–2.03)	—	0.230*
PMN-MDSCs	0.74 (−0.37–1.04)	0.75 (0.57–1.20)		0.390
Mo-MDSCs	0.44 (0.19–1.18)	0.53 (0.34–0.96)		0.544
Postoperative MDSC (%)	1.67 (1.15–3.92)	2.93 (1.65–5.00)	—	0.040*
PMN-MDSCs	1.04 (0.68–1.61)	1.18 (0.81–1.90)		0.356
Mo-MDSCs	0.88 (0.41–1.98)	1.41 (0.64–3.06)		0.351
Postoperative VAS
VAS for 2 hrs	2.0 (1.0–2.0)	1.0 (0.0–2.0)	—	0.108*
VAS for 24 hrs	1.0 (1.0–2.0)	2.0 (1.0–3.0)	—	0.044*

Notes: All data are presented as No. (%) or median (25–75% interquartile range), n=120. *Mann–Whitney test. ^†Chi-square (X²) test.

Abbreviations: BCS, breast-conserving surgery; SEV, sevoflurane-based anesthetic; TIVA, total intravenous anesthetic; Mo-MDSCs, monocytic myeloid-derived suppressor cells; PMN-MDSCs, polymorphonuclear myeloid-derived suppressor cells.

Figure 3 Representative dot plots of the population of MDSCs for different surgical methods. (A) Preoperative MDSCs of mastectomy. (B) Postoperative MDSCs of mastectomy. (C) Preoperative MDSCs of BCS. (D) Postoperative MDSCs of BCS.

Abbreviations: BCS, breast-conserving surgery; MDSCs, myeloid-derived suppressor cells.

Figure 4 (A) Representative histogram of flow cytometry analysis of Mo-MDSCs and PMN-MDSCs. (B) The frequency of Mo-MDSCs (P=0.018) and (C) PMN-MDSCs in MDSCs (P=0.022).

Abbreviations: MDSCs, myeloid-derived suppressor cells; Mo-MDSCs, monocytic myeloid-derived suppressor cells; PMN-MDSCs, polymorphonuclear myeloid-derived suppressor cells.

Figure 5 DFS by Kaplan–Meier analysis. (A) DFS in two anesthesia groups (P=0.138, log-rank test). (B) DFS in two surgical method groups (P=0.953, log-rank test).

Abbreviations: DFS, disease-free survival; SEV, sevoflurane-based anesthetic; TIVA, total intravenous anesthetic; BCS, breast-conserving surgery.

Figure 6 Overall survival (OS) by Kaplan–Meier analysis. (A) OS in two anesthesia groups (P=0.182, log-rank test). (B) OS in two surgical method groups (P=0.281, log-rank test).

Abbreviations: SEV, sevoflurane-based anesthetic; TIVA, total intravenous anesthetic; BCS, breast-conserving surgery.