PERIOPERATIVE BLOOD-TRANSFUSIONS DO NOT AFFECT DISEASE RECURRENCE OF PATIENTS UNDERGOING CURATIVE RESECTION OF COLORECTAL-CARCINOMA - A MAYO/NORTH CENTRAL CANCER-TREATMENT GROUP-STUDY
PERIOPERATIVE BLOOD-TRANSFUSIONS DO NOT AFFECT DISEASE RECURRENCE OF PATIENTS UNDERGOING CURATIVE RESECTION OF COLORECTAL-CARCINOMA - A MAYO/NORTH CENTRAL CANCER-TREATMENT GROUP-STUDY
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DOI：
10.1200/jco.1995.13.7.1671
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发表时间：
1995-07-01
影响因子：
45.3
通讯作者：
MOERTEL, CG
中科院分区：
文献类型：
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作者：
DONOHUE, JH;WILLIAMS, S;MOERTEL, CG
目的：为了评估围手术期输血对结直肠癌复发和患者生存率的影响，患者和方法：共1,051例患者接受根治性手术治疗的II期或III期结直肠腺癌进行了回顾性研究，围手术期输血对疾病复发和患者生存的影响。42%的患者接受了围手术期血液成分。结果：围手术期输血对单变量或多变量分析中的疾病进展没有影响。肿瘤分期（P = .0001），局部晚期肿瘤特征（粘连、累及邻近结构或穿孔; P = .0001）、位置（直肠vs结肠; P = .0002），等级（P < .001），细胞动力学曲线（非二倍体或高合成期百分比[%S] + gap 2有丝分裂期百分比[%G2M]; P = .0003）是肿瘤复发的最有力的独立预测因子。多变量分析显示，输血对总生存率无不良影响（P <0.004），肿瘤分期（P = 0.0001）、部位（P = 0.004）、分级（P = 0.001）、患者年龄（P = 0.0001）、性别（P <0.04）和细胞动力学特征（P = 0.0001）也无不良影响。在进一步评估输血对预后的影响时，全血输血后疾病复发的风险没有增加（P = .14），尽管接受全血的患者的疾病特异性生存率低于未输血的患者，结论：对于使用血液成分（最常见的是RBC）的输血实践，医学上指示的对结直肠癌患者的输血似乎对疾病复发没有影响。输血对癌症患者生存的不利影响更有可能是由于其他未评估的肿瘤变量或基础疾病，而不是输血成分诱导的免疫抑制导致的肿瘤复发增强。(C)1995年，美国临床肿瘤学会。
Purpose: To evaluate the effect of perioperative blood transfusions on colorectal cancer recurrence and patient survival.Patients and Methods: A total of 1,051 patients treated with curative surgery for stage II or III colorectal adenocarcinoma were retrospectively studied for the effect of perioperative blood transfusions on disease recurrence and patient survival. Forty-two percent of patients received perioperative blood components.Results: Perioperative transfusions had no effect on disease progression in univariate or multivariate analysis. Tumor stage (P = .0001), locally advanced tumor characteristics (adherence, involvement of adjacent structure, or perforation; P = .0001), location (rectal v colon; P = .0002), grade (P < .001), and cell kinetic profile (nondiploid or high percent synthetic phase [%S] + percent gap 2 mitosis phase [%G2M]; P = .0003) were the most powerful independent predictors of tumor recurrence. Use of transfusions was associated with on adverse effect on overall survival (P < .004) using multivariate analysis, as well as tumor stage (P = .0001), location (P = .004), grade (P = .001), patient age (P = .0001), sex (P < .04), and cell kinetic profile (P = .0001). In further evaluation of the prognostic effects of transfusions, there was no increased risk of disease recurrence after whole-blood transfusions (P = .14) as compared with packed RBC or no transfusions, although the disease-specific survival for patients who received whole blood was lower than for nontransfused patients (P < .005) and patients who received other blood components (P < .03).Conclusion: With transfusion practices that use blood components, most commonly RBCs, medically indicated transfusions to patients with colorectal carcinoma seem to have no impact on disease recurrence. The adverse impact of transfusions on cancer patient survival is more likely due to other unevaluated tumor variables or underlying illness rather than tumor recurrence enhancement by immunosuppression induced by transfusion of blood components. (C) 1995 by American Society of Clinical Oncology.