Anemia tolerance versus blood transfusion on long-term outcomes after colorectal cancer surgery: A retrospective propensity-score-matched analysis.
Anemia tolerance versus blood transfusion on long-term outcomes after colorectal cancer surgery: A retrospective propensity-score-matched analysis.
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DOI：
10.3389/fonc.2022.940428
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发表时间：
2022
影响因子：
4.7
通讯作者：
Miao, Changhong
中科院分区：
文献类型：
--
作者：
Weng, Meilin;Guo, Miaomiao;Li, Ting;Zhou, Changming;Sun, Caihong;Yue, Ying;Liao, Qingwu;Cai, Sanjun;Lu, Xihua;Zhou, Di;Miao, Changhong
关键词：
围手术期贫血与输血相互交织，均对结直肠癌（CRC）患者的生存产生不利影响。但在一些国家，贫血的治疗仍然依赖于输血，这使我们质疑贫血耐受和输血对CRC患者长期预后的影响。我们研究了术前贫血和术后贫血以及术前贫血和输血的联合作用，这对生存率有更大的风险，以比较贫血耐受和输血对接受CRC手术的患者的总生存率（OS）和无病生存率（DFS）的影响。一项回顾性倾向评分匹配分析纳入了2008年1月1日至2014年12月31日期间接受择期手术的CRC患者。在倾向评分匹配后，使用Kaplan-Meier生存分析和单变量和多变量考克斯比例风险模型来研究生存的预后因素。在单因素和多因素考克斯回归分析中，建立了两个新的模型。在8，121例CRC患者中，分别有1，975例（24.3%）和6，146例（75.7%）患者术前存在和不存在贫血。匹配后，每组各有1,690名患者。在术前贫血和术后贫血模型中，术前贫血和术后贫血是OS（HR，1.202; 95% CI，1.043-1.385; P=0.011）和DFS（HR，1.210; 95% CI，1.050-1.395; P=0.008）的独立危险因素。在术前贫血和输血模型中，术前贫血和输血是影响OS（HR，1.791; 95% CI，1.339-2.397; P<0.001）和DFS（HR，1.857; 95% CI，1.389-2.483; P<0.001）的最危险的独立预后因素。在术前贫血的患者中，输血患者的OS和DFS均低于未输血患者（OS P=0.026; DFS P=0.037）。在接受CRC手术的患者中，术前贫血和输血对OS和DFS的风险更大，表明与输血相关的危害大于与术后贫血相关的危害。这些发现应鼓励临床医生提高警惕，及时预防和治疗贫血，适当促进贫血的耐受性和限制CRC患者输血的使用。
Perioperative anemia and transfusion are intertwined with each other, and both have adverse impacts on the survival of colorectal cancer (CRC) patients. But the treatment of anemia still relies on transfusion in several countries, which leads us to question the effects of anemia tolerance and transfusion on the long-term outcomes of CRC patients. We investigated the combined effect of preoperative anemia and postoperative anemia and of preoperative anemia and blood transfusion, which imposes a greater risk to survival, to compare the effects of anemia tolerance and transfusion on overall survival (OS) and disease-free survival (DFS) in patients undergoing CRC surgery. A retrospective propensity-score-matched analysis included patients with CRC undergoing elective surgery between January 1, 2008, and December 31, 2014. After propensity-score matching, Kaplan–Meier survival analysis and univariable and multivariable Cox proportional hazards models were used to study the prognostic factors for survivals. In univariate and multivariate Cox regression analysis, two novel models were built. Of the 8,121 patients with CRC, 1,975 (24.3%) and 6,146 (75.7%) patients presented with and without preoperative anemia, respectively. After matching, 1,690 patients remained in each group. In the preoperative anemia and postoperative anemia model, preoperative anemia and postoperative anemia was independent risk factor for OS (HR, 1.202; 95% CI, 1.043–1.385; P=0.011) and DFS (HR, 1.210; 95% CI, 1.050–1.395; P=0.008). In the preoperative anemia and transfusion model, preoperative anemia and transfused was the most dangerous independent prognostic factor for OS (HR, 1.791; 95% CI, 1.339–2.397; P<0.001) and DFS (HR, 1.857; 95% CI, 1.389–2.483; P<0.001). In patients with preoperative anemia, the OS and DFS of patients with transfusion were worse than those of patients without transfusion (P=0.026 in OS; P=0.037 in DFS). Preoperative anemia and blood transfusion imposed a greater risk to OS and DFS in patients undergoing CRC surgery, indicating that the harm associated with blood transfusion was greater than that associated with postoperative anemia. These findings should encourage clinicians to be vigilant for the timely prevention and treatment of anemia, by appropriately promoting toleration of anemia and restricting the use of blood transfusion in patients with CRC.
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