Percentages of NK, NKT and T cells in the peripheral blood of patients with ESCC and control subjects, respectively. (A) Representative flow cytometry plots of NK, NKT and T cells, gated by CD3-CD56+, CD3+CD56+ or CD3+, respectively. (B) Percentages of NK and NKT cells in patients with ESCC and control subjects. * P<0.05. NK, natural killer; NKT, natural killer T; ESCC, esophageal squamous cell carcinoma; CD, cluster of differentiation; SSC, side-scattered light; FSC, forward scatter; APC, allophycocyanin; FITC, fluorescein isothiocyanate. 

Percentages of NK, NKT and T cells in the peripheral blood of patients with ESCC and control subjects, respectively. (A) Representative flow cytometry plots of NK, NKT and T cells, gated by CD3-CD56+, CD3+CD56+ or CD3+, respectively. (B) Percentages of NK and NKT cells in patients with ESCC and control subjects. * P<0.05. NK, natural killer; NKT, natural killer T; ESCC, esophageal squamous cell carcinoma; CD, cluster of differentiation; SSC, side-scattered light; FSC, forward scatter; APC, allophycocyanin; FITC, fluorescein isothiocyanate. 

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Postoperative immunosuppression is associated with the recurrence and metastasis of esophageal squamous cell carcinoma (ESCC). Propofol is a commonly used intravenous anesthetic and has been reported to be associated with immunosuppression; however, little is known about its effect on innate immune cells during the postoperative period in patients...

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... phenotype and function of NK cells from the peripheral blood of patients with ESCC. NK cells have been reported to be important for suppressing the recurrence and metas- tasis of tumor cells. Furthermore, it has been reported that immunosuppression occurs in the tumor microenvironment as well as the peripheral blood (23). The results of flow cytometry revealed that the percentage of NK cells gated by CD3-CD56+ in the peripheral blood of patients with ESCC (21.6±0.89%) was significantly increased compared with the control (11.8±0.54%; Fig. 1). Furthermore, the percentage of NKT cells gated by CD3+CD56+, another type of innate immune cell (24), was significantly increased in the peripheral blood of patients with ESCC compared with the control group (3.99±0.43 vs. 1.15±0.10); Fig. 1), indicating that the innate immune response activity was ...
Context 2
... phenotype and function of NK cells from the peripheral blood of patients with ESCC. NK cells have been reported to be important for suppressing the recurrence and metas- tasis of tumor cells. Furthermore, it has been reported that immunosuppression occurs in the tumor microenvironment as well as the peripheral blood (23). The results of flow cytometry revealed that the percentage of NK cells gated by CD3-CD56+ in the peripheral blood of patients with ESCC (21.6±0.89%) was significantly increased compared with the control (11.8±0.54%; Fig. 1). Furthermore, the percentage of NKT cells gated by CD3+CD56+, another type of innate immune cell (24), was significantly increased in the peripheral blood of patients with ESCC compared with the control group (3.99±0.43 vs. 1.15±0.10); Fig. 1), indicating that the innate immune response activity was ...

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... For instance, in the peripheral blood of patients with colon cancer, propofol increased the expression levels of activated p30 and p44 in NK cells, which can promote the activation and proliferation of NK cells [118]. Additionally, in the peripheral blood of patients with esophageal squamous cell carcinoma, propofol enhanced the expression of cytotoxic effector molecules, such as granzyme B and IFN-γ, indicating enhanced NK cytotoxicity [119]. Regarding the cytokine profile, propofol downregulates the levels of proinflammatory cytokines, such as IL-1β, IL-6, and TNF-α [120], and inhibits PGE2 and COX activity [121]. ...
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... Even more, propofol may prevent immunosuppression through the preservation of NK cell function. Not only propofol preserved NK activity, it seemed that propofol could also stimulate the proliferation of NK cells through the increased expression of granzyme B, IFN-γ, and activating surface receptors (e.g., CD16, NKp30, NKp44, and NKG2D) [76][77][78]. In fact, increased NK cell infiltration of tumors is reported after the administration of propofol. ...
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... Through experiments conducted in mice, Inada et al. (2009b) proved that propofol-differentiated DCs could significantly improve the activity of NK cells. Also, research in 2018 reported that by influencing the expression of activating or inhibitory receptors, the cytotoxicity of NK cells in postoperative patients with esophageal squamous cell carcinoma could be upregulated by propofol (Zhou et al., 2018). PGE2 could suppress the production of IFN-γ from NK cells via the EP4 receptor. ...
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... antagonists) [25]. According to several studies, administration of propofol-based anesthesia increased the cytotoxicity of NK cells compared with volatile anesthetics [26][27][28][29]. The cyclooxygenase-2 expression has been linked to immune suppression and tumor progression mainly through the production of prostaglandin E2 that inhibits NK cell cytotoxicity [30]. ...
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Propofol as an intravenous anesthetic and isoflurane as an inhalational/volatile anesthetic continue to be an important part of surgical anesthetic interventions worldwide. The impact of these anesthetics on tumor progression, immune modulation, and survival rates of cancer patients has been widely investigated. Although most of the pre-clinical studies have provided a beneficial effect of propofol over isoflurane or other volatile anesthetics, several investigations have shown contradictory results, which warrant more pre-clinical and clinical studies. Propofol mostly exhibits anti-tumor properties, while isoflurane being a cost-effective anesthetic is frequently used. However, isoflurane has been also reported with protumorigenic activity. This review provides an overall perspective on the network of signaling pathways that may modulate several steps of tumor progression from inflammation, immunomodulation, epithelial-mesenchymal transition (EMT) to invasion, metastasis, angiogenesis, and cancer stemness and extracellular vesicles along with chemotherapeutic applications and clinical status of these anesthetics. A clear understanding of the mechanistic viewpoints of these anesthetics may pave the way for more prospective clinical trials with the ultimate goal of obtaining a safe and optimal anesthetic intervention that would prevent cancer recurrence and may influence better postoperative survival.
... Such effect on NK cells has been linked to an increase in the expression of granzyme B, IFNγ, and activating surface receptors (CD16, NKp30, NKp44, and NKG2D) as well as a reduction in the formation of PGE2. [119][120][121] The beneficial effect of propofol in tumor metastasis has been demonstrated in animals. When rats having surgery were anesthetized with propofol the function of NK cells remained unchanged and metastatic formation was lower than animals receiving volatile anesthetics. ...
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Juan P Cata,1,2 Carlos Guerra,3 German Soto,4 Maria F Ramirez1,2 1Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 2Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA; 3Department of Anesthesia, Pain Management, and Perioperative Medicine, Henry Ford Hospital, Detroit, MI, USA; 4Department of Anesthesiology, Hospital Eva Perón, Rosario, Santa Fe, ArgentinaCorrespondence: Juan P CataDepartment of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Centre, 1515 Holcombe Blvd., Unit 409, Houston, TX 77005, USATel/Fax +1 713-792-4582Email JCata@mdanderson.orgAbstract: Surgery is a critical period in the survival of patients with cancer. While resective surgery of primary tumors has shown to prolong the life of these patients, it can also promote mechanisms associated with metastatic progression. During surgery, patients require general and sometimes local anesthetics that also modulate mechanisms that can favor or reduce metastasis. In this narrative review, we summarized the evidence about the impact of local, regional and general anesthesia on metastatic mechanisms and the survival of patients. The available evidence suggests that cancer recurrence is not significantly impacted by neither regional anesthesia nor volatile or total intravenous anesthesia.Keywords: neoplasm, surgery, anesthesia, recurrence