Dresner S M, Lamb P J, Shenfine J, Hayes N, Griffin S M
Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Eur J Surg Oncol. 2000 Aug;26(5):492-7. doi: 10.1053/ejso.1999.0929.
Peri-operative allogeneic blood transfusion may exert an immunomodulatory effect and has been associated with early recurrence and decreased survival following resection for several gastro-intestinal malignancies. The aim of this study was to evaluate the prognostic influence of transfusion requirements following radical oesophagectomy for cancer.
A consecutive series of 235 patients undergoing subtotal oesophagectomy with two-field lymphadenectomy in a single centre from April 1990 to June 1999 were studied.
The median age was 64 years (30-79) with a male to female ratio of 3:1. The predominant histological subtype was adenocarcinoma (n = 154) compared to squamous carcinoma (n = 81). To avoid the influence of surgical complications data were excluded from the 5.5% of patients suffering in-hospital mortality. In the remaining patients, median blood loss was 900 ml (200-5500) with 46% (103/222) requiring transfusion (median 3 units, range 2-21). Median survival of non-transfused patients was 36 months compared to only 19 months for those receiving transfusion (log-rank = 4.44; 1 df, P = 0.0352). Non-transfused patients had significantly higher 2 and 5-year survival rates of 62% and 41% respectively in contrast to only 40% and 25% in those receiving blood transfusion. Even after stratification of results according to disease stage or the presence of major complications, survival was significantly worse in those receiving transfusion. Multivariate analysis demonstrated that in addition to nodal status, > 4 units transfusion was an independent prognostic indicator.
Post-operative transfusion is associated with a significantly worse prognosis following radical oesophagectomy. Meticulous haemostasis and avoidance of unnecessary transfusion may prove oncologically beneficial.
围手术期同种异体输血可能产生免疫调节作用，并与多种胃肠道恶性肿瘤切除术后的早期复发及生存率降低有关。本研究旨在评估食管癌根治术后输血需求对预后的影响。
对1990年4月至1999年6月在单一中心接受次全食管切除术及两野淋巴结清扫术的235例患者进行连续研究。
患者中位年龄为64岁（30 - 79岁），男女比例为3:1。主要组织学亚型为腺癌（n = 154），鳞状细胞癌为（n = 81）。为避免手术并发症的影响，将5.5%院内死亡患者的数据排除。其余患者中，中位失血量为900 ml（200 - 5500），46%（103/222）需要输血（中位输血量3单位，范围2 - 21）。未输血患者的中位生存期为36个月，而输血患者仅为19个月（对数秩检验 = 4.44；1自由度，P = 0.0352）。未输血患者2年和5年生存率分别显著高于输血患者，分别为62%和41%，而输血患者仅为40%和25%。即使根据疾病分期或是否存在主要并发症对结果进行分层，输血患者的生存率仍显著较差。多因素分析表明，除淋巴结状态外，输血> 4单位是一个独立的预后指标。
食管癌根治术后输血与预后显著较差相关。细致的止血及避免不必要的输血可能在肿瘤学方面有益。
