Tachibana M, Tabara H, Kotoh T, Kinugasa S, Dhar D K, Hishikawa Y, Masunaga R, Kubota H, Nagasue N
Second Department of Surgery, Shimane Medical University, Izumo, Japan.
Am J Gastroenterol. 1999 Mar;94(3):757-65. doi: 10.1111/j.1572-0241.1999.00948.x.
The perioperative blood transfusions have been associated with tumor recurrence and decreased survival in various types of alimentary tract cancer. There exist, however, contradictory studies showing no relationship between blood transfusions and survival. For patients with esophageal cancer, only one report suggested that blood transfusions did not by itself decrease the chance of cure after esophagectomy.
Among 235 patients with primary squamous cell carcinoma of the thoracic esophagus between December 1979 and March 1998, 143 patients (60.9%) underwent esophagectomy with curative intent (RO). To exclude the effects of surgery-related postoperative complications, 14 patients who died within 90 days during the hospital stay were excluded. Thus, clinicopathological characteristics and prognostic factors were retrospectively investigated between patients with no or few transfusions (< or = 2 units) (n = 58), and much transfused patients (> or = 3 units) (n = 71).
Sixty-three patients are alive and free of cancer, and 66 patients are dead. A total of 98 patients (76%) received blood transfusions, whereas 31 patients (24%) had no transfusion. The amount of blood transfused was 1 or 2 units in 27 patients (27.6%), 3 or 4 units in 33 (33.7%), 5 or 6 units in 20 (20.4%), and > or = 7 units in 18 (18.4%). The 5-yr survival rate for patients with no or few transfusions was 69%, whereas that for much transfused patients was 31.7% (p < 0.0001). The much transfused patients had more prominent ulcerative tumor, longer time of operation, more estimated blood loss, and more marked blood vessel invasion than the group with no or few transfusions. The factors influencing survival rate were tumor location, Borrmann classification, size of tumor, depth of invasion, number of lymph node metastases, time of operation, amount of blood transfusions, lymph vessel invasion, and blood vessel invasion. Among those nine significant variables verified by univariate analysis, independent prognostic factors for survival determined by multivariate analysis were number of lymph node metastasis (0 or 1 vs > or = 2, p < 0.0001), amount of blood transfusions (< or = 2 units vs > or = 3 units, p < 0.0001), and blood vessel invasion (marked vs non-marked, p = 0.0207).
There is an association between high amount of blood transfusions and decreased survival for patients with resectable esophageal cancer. To improve the prognosis, surgeons must be careful to reduce blood loss during esophagectomy with extensive lymph node dissection and subsequently must minimize blood transfusions.
围手术期输血与各种类型消化道癌的肿瘤复发及生存率降低有关。然而，也有相互矛盾的研究表明输血与生存率之间并无关联。对于食管癌患者，仅有一份报告指出输血本身并不会降低食管切除术后的治愈几率。
在1979年12月至1998年3月期间收治的235例原发性胸段食管鳞状细胞癌患者中，143例（60.9%）接受了根治性食管切除术（RO）。为排除手术相关术后并发症的影响，排除了14例住院期间90天内死亡的患者。因此，对未输血或少量输血（≤2单位）患者（n = 58）和大量输血患者（≥3单位）（n = 71）的临床病理特征及预后因素进行了回顾性研究。
63例患者存活且无癌，66例患者死亡。共有98例患者（76%）接受了输血，而31例患者（24%）未输血。输血量为1或2单位的患者有27例（27.6%），3或4单位的有33例（33.7%），5或6单位的有20例（20.4%），≥7单位的有18例（18.4%）。未输血或少量输血患者的5年生存率为69%，而大量输血患者的5年生存率为31.7%（p < 0.0001）。大量输血患者的肿瘤溃疡更明显，手术时间更长，估计失血量更多，血管侵犯更显著，与未输血或少量输血组相比。影响生存率的因素有肿瘤位置、Borrmann分型、肿瘤大小、浸润深度、淋巴结转移数量、手术时间、输血量、淋巴管侵犯和血管侵犯。在单因素分析验证的这9个显著变量中，多因素分析确定的生存独立预后因素为淋巴结转移数量（0或1个 vs ≥2个，p < 0.0001）、输血量（≤2单位 vs ≥3单位，p < 0.0001）和血管侵犯（显著 vs 不显著，p = 0.0207）。
可切除食管癌患者大量输血与生存率降低之间存在关联。为改善预后，外科医生在进行广泛淋巴结清扫的食管切除术中必须注意减少失血，并随后尽量减少输血。
