Oncology outcomes
Propofol vs sevoflurane and breast cancer survival
Open access · cc by · source: Europe PMC
In the CAN randomised trial, five-year overall survival after primary breast cancer surgery was essentially the same with propofol or sevoflurane maintenance anaesthesia.
Study at a glance
- Design
- RCT — 1:1 propofol vs sevoflurane for anaesthesia maintenance in curative primary breast cancer surgery
- N
- N=1670 · ITT: 841 propofol, 829 sevoflurane
- Population
- Patients undergoing curative primary breast cancer surgery
- Outcome
- 5-year overall survival
Structured fields used in claim comparison tables when every cited study has a complete layer.
Key findings
Among 1670 patients analysed by intention to treat (841 propofol, 829 sevoflurane), five-year survival was about 92% in both arms, with a hazard ratio near 1 and no statistically significant difference. Results were similar after per-protocol analysis and adjustment for uneven triple-negative receptor status.
Methodology
Investigators randomly allocated patients having curative primary breast cancer surgery to propofol or sevoflurane for anaesthesia maintenance in a 1:1 ratio. The primary endpoint was 5-year overall survival in intention-to-treat and per-protocol analyses.
Limitations
Equivalence for rare mortality outcomes is hard to prove even in a large trial, and opioid co-analgesia differed by arm. Findings apply to primary breast cancer surgery, not all cancer types, and further trials are still needed for guideline change.
How this study connects
Role on claims
Each row is a claim on a concept or method page where this paper supports, challenges, or qualifies the statement. Roles are hand-checked — not a model guess.
Multiple studies in this library examine oncology outcomes with empirical patient or population outcomes rather than opinion alone.
Evidence for the claim as stated.
Among 1670 patients analysed by intention to treat (841 propofol, 829 sevoflurane), five-year survival was about 92% in both arms, with a hazard ratio near 1 and no statistically significant difference. Results were similar after per-protocol analysis and adjustment for uneven triple-negative receptor status.
Evidence for the claim as stated.
Effect sizes and settings differ across oncology outcomes studies — digital vs clinic, trial vs observational — so results should not be pooled casually.
Evidence for the claim as stated.
A randomised trial can still use Cox (or a closely related survival contrast) as the primary analysis. Patients undergoing curative breast-cancer surgery randomised to propofol versus sevoflurane had five-year overall survival around 92% in both arms, with a hazard ratio near 1 and no statistically significant difference in intention-to-treat or per-protocol analyses.
Evidence for the claim as stated.
The same modelling family is asked to do two different jobs: describe inequalities and exposures in cohorts, versus test a randomised intervention. The SES-cancer and OSA papers cannot name a single causal mechanism or a treatment that would close the HR gap, whereas the propofol–sevoflurane trial can say the assigned anaesthetic did not shift 5-year survival under its protocol. Reading every HR as if it were that trial overclaims the observational papers and underclaims the trial's design.
Evidence for the claim as stated.
Null and protective HRs are not interchangeable with 'safe' or 'preventive.' The anaesthetic trial's HR near 1 is limited by rare mortality and differing opioid co-analgesia; the alcohol paper's HR 0.72 cannot prove drinking prevents depression; the antidepressant-adverse-event cohort links several drugs to more falls versus non-use, which may still be confounding by indication.
Evidence for the claim as stated.
A large surgical trial can be ITT-null. Among 1,670 patients having curative primary breast-cancer surgery (841 propofol, 829 sevoflurane), five-year overall survival was about 92% in both arms, with a hazard ratio near 1 and no statistically significant difference. Results were similar after per-protocol analysis and after adjustment for uneven triple-negative receptor status. Equivalence for rare deaths is still hard to prove; opioid co-analgesia also differed by arm.
Evidence for the claim as stated.
ITT and per-protocol can disagree on whether a result 'counts.' MOBITEL's primary ITT contrast was P=.06 while per-protocol reached P=.04; the propofol–sevoflurane trial was null on both. Quoting only the significant per-protocol RRR in MOBITEL, or reading the anaesthetic HR near 1 as proven equivalence, treats two different estimands as if they were one.
Evidence for the claim as stated.
Patients having curative primary breast-cancer surgery were randomised 1:1 to propofol or sevoflurane. Among 1,670 analysed by intention to treat (841 propofol, 829 sevoflurane), five-year overall survival was about 92% in both arms, with a hazard ratio near 1 and no statistically significant difference. Per-protocol analysis and adjustment for uneven triple-negative receptor status agreed. Rare mortality still makes equivalence hard to prove; opioid co-analgesia differed by arm.
Evidence for the claim as stated.
KM in a randomised anaesthetic trial, KM in a biomarker series, KM in a screening cohort, and an 8-week app RCT are not one method applied four times. Propofol versus sevoflurane can say assigned anaesthetic did not shift 5-year OS (~92%, HR near 1). ANXA1's HR 1.70 in HER2-positive overexpression is an observational 10-year BCSS association. NZ ethnic survival gaps change when the sample is restricted to screen-detected cancers. IntelliCare did not analyse cancer death at all.
Evidence for the claim as stated.
Open questions
Tensions this paper is part of
From concept pages' “where studies disagree.” Disagreement means the same question; scope means different assays, populations, or outcomes.
Effect sizes and settings differ across oncology outcomes studies — digital vs clinic, trial vs observational — so results should not be pooled casually.
- Supports · ANXA1 in breast cancer prognosis
- Supports · Does socioeconomic status change cancer survival?
The same modelling family is asked to do two different jobs: describe inequalities and exposures in cohorts, versus test a randomised intervention. The SES-cancer and OSA papers cannot name a single causal mechanism or a treatment that would close the HR gap, whereas the propofol–sevoflurane trial can say the assigned anaesthetic did not shift 5-year survival under its protocol. Reading every HR as if it were that trial overclaims the observational papers and underclaims the trial's design.
- Supports · Individual SES and cancer survival
- Supports · OSA severity and cardiovascular risk
Null and protective HRs are not interchangeable with 'safe' or 'preventive.' The anaesthetic trial's HR near 1 is limited by rare mortality and differing opioid co-analgesia; the alcohol paper's HR 0.72 cannot prove drinking prevents depression; the antidepressant-adverse-event cohort links several drugs to more falls versus non-use, which may still be confounding by indication.
- Supports · Wine, alcohol, and depression
- Supports · Antidepressant adverse events cohort
ITT and per-protocol can disagree on whether a result 'counts.' MOBITEL's primary ITT contrast was P=.06 while per-protocol reached P=.04; the propofol–sevoflurane trial was null on both. Quoting only the significant per-protocol RRR in MOBITEL, or reading the anaesthetic HR near 1 as proven equivalence, treats two different estimands as if they were one.
KM in a randomised anaesthetic trial, KM in a biomarker series, KM in a screening cohort, and an 8-week app RCT are not one method applied four times. Propofol versus sevoflurane can say assigned anaesthetic did not shift 5-year OS (~92%, HR near 1). ANXA1's HR 1.70 in HER2-positive overexpression is an observational 10-year BCSS association. NZ ethnic survival gaps change when the sample is restricted to screen-detected cancers. IntelliCare did not analyse cancer death at all.
- Supports · ANXA1 in breast cancer prognosis
- Supports · Screening and breast cancer equity in NZ
- Supports · Coaching vs recommendations in IntelliCare
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