Effect of neoadjuvant chemotherapy on inflammatory factors during perioperative period and early postoperative hyperalgesia in patients with breast cancer

Abstract

Objective To investigate the effect of neoadjuvant chemotherapy on inflammatory factors and early postoperative hyperalgesia in patients undergoing modified radical mastectomy. Methods A cohort study was designed. Eighty female patients (20-60 years old) with American Society of Anesthesiologists (ASA) grades of Ⅰ, Ⅱ and body mass index 20-28 kg/m2, undergoing modified radical mastectomy were divided into neoadjuvant chemotherapy group (group N) or control group (group C) according to whether they received neoadjuvant chemotherapy. Each group has 40 cases. All patients took the standard anesthesia management. Patients′ general condition, intraoperative parameters (such as duration of operation, volume of intraoperative bleeding and blood transfusion, dosage of anesthetics, etc) and postoperative parameters (postoperative adverse effects) were recorded. We also collected 3 ml peripheral blood from patients at five time points [before the beginning of anesthesia (T1), after endotracheal intubation (T2), after skin incision (T3), after tube extraction (T4), 24 h after the operation (T5)] to detect the serum cytokines, such as interleukin (IL)-1β, IL-6, IL-8 and transforming growth factor- β (TGF-β). Pain intensity scores were recorded at point of 24 h after surgery (T5), 48 h after surgery (T6), 72 h after surgery (T7) by Numerical Rating Scale (NRS) score. If the NRS>4, intravenous nefopam 20 mg to analgesia, evaluated again 30 minutes later. Results The NRS scores of T5-T7 in group N were higher than scores in group C. The difference between the two groups was statistically significant (P<0.05). The concentrations of IL1-β, IL-6, IL-8 at each time point of T1-T5 in group N were higher than those concentrations of group C. The difference between the two groups was statistically significant (P<0.05). The concentration of TGF-β at each time point of T1-T5 in group N was lower than that of group C. The difference between the two groups was statistically significant (P<0.05). Conclusions Additional adjuvant chemotherapy can increase the pain extent the post-operative pain at 24-72 h after surgery in female patients with breast cancer. These increase of the acute pain can be attribute to the increased expression of IL-1β, IL6 and IL-8 perioperative cytokines and the down-regulation of the expression of TGF-β. Key words: Neoadjuvant chemotherapy; Breast carcinoma; Inflammatory factor; Pain; Hyperalgesia