Effect of Propofol on breast Cancer cell, the immune system, and patient outcome

Abstract

Breast cancer is the second leading cause of cancer death in women. Surgery is the first line of treatment for breast cancer. Retrospective clinical studies suggest that the type of anesthesia administered during oncological surgery may influence patient outcome. Propofol, the widely used intravenous anesthetic agent, may lead to better outcomes compared to volatile anesthetics. Here we review the literature on the effect of propofol in breast cancer cells, the immune system, pain management, and patient outcomes. Evidence from the study of breast cancer cell lines suggests that high concentrations of propofol have both anti-tumor and pro-tumor effects. Propofol and volatile anesthetics have different effects on the immune system. Propofol has also been shown to reduce the development and severity of acute and chronic pain following surgery. Although a retrospective study that included many types of cancer indicated that propofol increases the long-term survival of patients following surgery, the evidence for this in breast cancer is weak. It has been shown that Propofol combined with paravertebral block led to change of serum composition that affects the breast cancer cell behaviors and natural killer cell activity. Prospective studies are in progress and will be finished within 5 years. The existing evidence is not sufficient to warrant changes to current anesthetic management. Further research is needed to clarify the mechanisms by which propofol affects cancer cells and the immune system.

Keywords: Breast Cancer; Migration; Natural killer cell; Proliferation; Propofol.

Fig. 1

Proposed mechanisms for the anti-tumor effects of propofol. Propofol impairs cell proliferation through inhibition of NF-kB pathway. It also reduces cell migration and invasion by inhibiting NET1, and decreasing the secretion of MMP2/MMP9

Fig. 2

Proposed mechanisms for the pro-tumor effects of propofol. Propofol enhances migration of breast cancer cells by increasing intracellular Ca²⁺ level and rearrangement of F-action. Propofol also promotes cell proliferation through Nrf2 pathway, and inhibits apoptosis by decreasing the expression of p53 and caspase-3