Blood transfusions and the subsequent risk of cancers in the United States elderly.
Blood transfusions and the subsequent risk of cancers in the United States elderly.
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DOI：
10.1111/trf.12071
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发表时间：
2013-10
期刊：
影响因子：
2.9
通讯作者：
Pfeiffer RM
中科院分区：
文献类型：
--
作者：
Riedl R;Engels EA;Warren JL;Berghold A;Ricker W;Pfeiffer RM
输血在老年人中很常见，也可能调节免疫系统。然而，输血对老年人癌症风险的影响尚未研究。美国一项基于人群的病例对照研究评估了输血后的癌症风险，该研究使用了从癌症登记处确定的 552,951 名老年病例和 100,000 名频率匹配的对照。使用医疗保险索赔确定癌症诊断或选择日期之前 0-12 个月、13-30 个月和 31-48 个月接受的输血。使用逻辑回归计算优势比 (OR) 和 95% 置信区间 (CI)。针对多次测试调整的 Bonferroni 校正。癌症诊断/选择前0-12个月接受输血与总体癌症风险显着升高（OR=2.05；95% CI：1.95-2.16）以及胃癌、结肠癌、肝癌、肾癌/肾盂/输尿管癌、淋巴瘤、骨髓瘤和白血病风险显着升高相关。在之前的两个时间间隔中，没有观察到总体上与癌症存在显着关联。没有任何部位与诊断/选择前 13-30 或 31-48 个月接受的输血相关。尽管如此，总体癌症风险随着输血周期次数的增加而增加（p 趋势 < 0.0001）。输血后 0-12 个月，整体癌症和特定部位的风险升高，并与多次输血相关，可能是由于反向因果关系，即初期癌症或癌症前兆导致贫血。
Blood transfusions are common in older adults, and also may modulate the immune system. However, the impact of transfusion on cancer risk in the elderly has not been studied. Cancer risk after blood transfusion was evaluated in a U.S. population-based case-control study using 552,951 elderly cases identified from cancer registries and 100,000 frequency-matched controls. Transfusions received 0–12 months, 13–30 months and 31–48 months prior to cancer diagnosis or selection date were identified using Medicare claims. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regressions. A Bonferroni correction adjusted for multiple testing. Transfusions received 0–12 months before cancer diagnosis/selection were associated with significantly elevated risk of cancer overall (OR=2.05; 95% CI: 1.95–2.16), and cancers of the stomach, colon, liver, kidney/renal pelvis/ureter, lymphoma, myeloma and leukemia. No significant associations for cancer overall were observed for the two earlier intervals. No site was associated with transfusions received 13–30 or 31–48 months before diagnosis/selection. Nonetheless, overall cancer risk increased with the number of transfused periods (p-trend < 0.0001). Risk of overall cancer and specific sites was elevated 0–12 months after blood transfusion and associated with multiple transfusions, possibly due to reverse causation, i.e. incipient cancers or cancer precursors causing anemia.
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