Prognosis and postoperative lymphocyte count in patients with hepatocellular carcinoma who received intraoperative allogenic blood transfusion: A retrospective study
Prognosis and postoperative lymphocyte count in patients with hepatocellular carcinoma who received intraoperative allogenic blood transfusion: A retrospective study
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DOI：
10.1016/j.ejso.2007.02.010
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发表时间：
2008-03-01
期刊：
影响因子：
3.8
通讯作者：
Kitano, S.
中科院分区：
文献类型：
--
作者：
Sugita, S.;Sasaki, A.;Kitano, S.
目的：围手术期输血对肝细胞癌（HCC）生存的影响尚未得到充分研究。为了明确术中输血对预后的价值，我们对224例行肝切除术的HCC患者进行了回顾性比较分析。方法：比较术中输血患者（n = 101）和未输血患者（n = 123）的临床病理背景和肝切除术后生存率。结果：输血患者肿瘤较大，血管侵犯频率高于未输血患者。接受输血的患者在肝切除术后的5年癌症相关生存率显著低于未接受输血的患者（38.3% vs. 66.7%, P < 0.01）。多因素分析显示术中输血（P = 0.02）、显微门静脉侵入（P < 0.01）、术前血清甲胎蛋白升高（P = 0.03）是肝切除术后预后不良的独立危险因素。输血对术后生存的负面影响仅在肿瘤直径大于50mm的患者中观察到。术后第1天，输血患者外周血淋巴细胞绝对计数（880/mm(3)）明显低于未输血患者（1081/mm(3)） （p < 0.01）。结论：我们的数据表明，术中输血导致术后早期免疫抑制，允许切除后残余HCC的进展。因此，对于可切除的HCC患者，尤其是大肿瘤患者，术中应避免输血。(c) 2007 Elsevier Ltd.版权所有。
Aims: The effect of perioperative blood transfusion on the survival of hepatocellular carcinoma (HCC) has not been fully investigated. To clarify the prognostic value of intraoperative allogenic blood transfusion, we conducted a comparative retrospective analysis of 224 patients with HCC who underwent hepatic resection.Methods: We compared clinicopathologic background and survival after hepatic resection between patients who received intraoperative blood transfusion (n = 101) and those who did not (n = 123).Results: Patients with blood transfusion had a larger tumor and more frequent vascular invasion than those without blood transfusion. The 5-year cancer-related survival rate after hepatic resection, but not the disease-free survival rate, was significantly lower in patients who underwent blood transfusion than in those who did not (38.3% vs. 66.7%, P < 0.01). Multivariate analysis showed intraoperative blood transfusion (P = 0.02), microscopic portal invasion (P < 0.01), and preoperative serum alpha-fetoprotein elevation (P = 0.03) to be independent risk factors for poor outcome after hepatic resection. The negative effect of blood transfusion on postoperative survival was observed only in patients with a tumor larger than 50 mm in diameter. The absolute peripheral blood lymphocyte count on postoperative day I was significantly lower in patients who underwent blood transfusion (880/mm(3)) than in those who did not (1081/mm(3)) (p < 0.01).Conclusions: Our data suggest that intraoperative blood transfusion results in immunosuppression in the early postoperative period, allowing for progression of residual HCC after resection. Therefore, intraoperative allogenic blood transfusion should be avoided in patients with resectable HCC, particularly in those with a large tumor. (c) 2007 Elsevier Ltd. All rights reserved.