BLOOD-TRANSFUSIONS AND PROGNOSIS IN COLORECTAL-CANCER
BLOOD-TRANSFUSIONS AND PROGNOSIS IN COLORECTAL-CANCER
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DOI：
10.1056/nejm199305133281902
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发表时间：
1993-05-13
影响因子：
158.5
通讯作者：
JEEKEL, J
中科院分区：
文献类型：
--
作者：
BUSCH, ORC;HOP, WCJ;JEEKEL, J
背景资料。输血可能会对接受手术治疗的癌症患者的预后产生不利影响，尽管还没有明确的证据表明这种不利影响，方法。我们进行了一项随机试验，以调查与目前的异体输血相比，自体输血方案是否会改善结直肠癌患者的预后。自体输血组患者在手术前需献血2单位。共有475名患者接受了评估。我们发现异体输血组(236例)和自体输血组(239例)的预后没有显著差异，4年结直肠癌特异性生存率分别为67%和62%(P=0.39)。在接受根治性手术的423例患者中，异基因输血组66%的患者和自体输血组63%的患者在4年内没有复发结直肠癌(P=0.93)。我们还发现，与不需要输血的患者相比，接受异体或自体输血的患者复发风险显著增加；相对复发率分别为2.1(P=0.01)和1.8(P=0.04)；这些比率彼此之间没有显著差异。与异体血相比，使用自体血输注并不能改善结直肠癌患者的预后。无论输血的类型如何，输血都与预后不良有关，可能是因为需要输血的情况。
Background. Blood transfusions may adversely affect the prognosis of patients treated surgically for cancer, although definite proof of this adverse effect has not been reported,Methods. We carried out a randomized trial to investigate whether the prognosis in patients with colorectal cancer would be improved by a program of autologous blood transfusion as compared with the current practice of allogeneic transfusion. Patients in the autologous-transfusion group were required to donate two units of blood before surgery.Results. A total of 475 patients were evaluated. We found no significant difference in prognosis between the allogeneic-transfusion group (236 patients) and the autologous-transfusion group (239 patients); colorectal cancer-specific survival rates at four years were 67 percent and 62 percent, respectively (P = 0.39). Among the 423 patients who underwent curative surgery, 66 percent of those in the allogeneic-transfusion group and 63 percent of those in the autologous-transfusion group had no recurrence of colorectal cancer at four years (P = 0.93). We also found that the risk of recurrence was significantly increased in patients who received blood transfusions, either allogeneic or autologous, as compared with patients who did not require transfusions; the relative rates of recurrence were 2.1 (P = 0.01) and 1.8 (P = 0.04), respectively; these rates did not differ significantly from each other.Conclusions. The use of autologous blood as compared with allogeneic blood for transfusion does not improve the prognosis in patients with colorectal cancer. Regardless of their type, transfusions are associated with poor prognosis, probably because of the circumstances that necessitate them.