Sevoflurane Anesthesia Selectively Boosts `CALML5` Expression in Breast Cancer Tissue Compared to Propofol

Treatment for breast cancer often involves surgery, where the choice of anesthetic might subtly influence tumor biology. Emerging evidence suggests anesthetics can modulate immune responses, inflammation, and intracellular calcium signaling, pathways critical for cancer progression and metastasis. However, the specific impact of common anesthetics like sevoflurane or propofol on calcium-related molecular expression directly within human breast cancer tissue has remained largely unexplored, representing a significant knowledge gap in optimizing perioperative care and understanding long-term oncological outcomes.

This prospective, randomized study enrolled 38 female patients undergoing breast cancer surgery, assigning n=19 to the sevoflurane group and n=19 to the propofol group for general anesthesia. Paired tumor and adjacent normal tissues were collected intra-operatively. Researchers quantified mRNA expression of RYR2 and CALML5 using RT-qPCR and assessed protein levels via Western blotting. Primary clinical endpoints included 24-hour resting numerical rating scale (NRS) for pain, quality of recovery-15 (QoR-15) on post-operative day 1, chronic incision pain at 3 and 6 months, and 6-month tumor recurrence or metastasis rates.

Compared with the propofol group, sevoflurane anesthesia significantly increased CALML5 mRNA and protein expression in breast cancer tissue (P<0.001). While RYR2 mRNA and protein expression showed a non-significant upward trend with sevoflurane (P>0.05), the differential effect on CALML5 was pronounced. Despite these molecular shifts, no significant intergroup differences were detected in clinical outcomes. Specifically, 24-hour NRS scores, post-operative QoR-15 scores, chronic incision pain at 3 or 6 months, and 6-month tumor recurrence or metastasis rates were all statistically similar between groups (all P>0.05). This suggests that while anesthetic choice can modulate specific calcium signaling genes, these particular changes did not translate into measurable short-term clinical differences within the study's scope.