Modin S, Karlsson G, Wählby L, Wählby L
Department of Surgery, Kärnsjukhuset, Skövde, Sweden.
Eur J Surg. 1992 Jun-Jul;158(6-7):371-5.
Because perioperative blood transfusions have been shown to have an impaired effect on survival in patients with colorectal cancer, we examined retrospectively the records of 882 patients who had undergone curative operations: 170 patients had distant metastases at the time of operation. Of the 499 patients with colonic cancer 332 (67%) had received perioperative blood transfusions. The corresponding figure for the 213 patients with rectal cancer was 190 (89%). Colonic tumors recurred in 45% of the patients who received blood transfusions and in 39% of those who did not. Corresponding figures for tumors in the rectum were 54% and 55%. When dividing the patients with colonic cancer into different subgroups according to Dukes' grade we found differences in survival rates. The poorer survival for transfused patients was, however, only significant for those with Dukes' A tumors (p less than 0.05). This difference disappeared when the influence of age was eliminated. The estimated risk ratio of recurrence and death was 1.23 with the 95% confidence interval (0.99, 1.53) when taking Dukes' grade, current age and localization into account. Blood transfusion should be avoided if possible until adequate prospective studies have been carried out.
由于围手术期输血已被证明对结直肠癌患者的生存率有不良影响，我们回顾性研究了882例行根治性手术患者的记录：170例患者在手术时已有远处转移。在499例结肠癌患者中，332例（67%）接受了围手术期输血。213例直肠癌患者的相应数字为190例（89%）。接受输血的患者中45%出现结肠肿瘤复发，未输血患者中这一比例为39%。直肠癌肿瘤复发的相应数字分别为54%和55%。根据Dukes分期将结肠癌患者分为不同亚组时，我们发现生存率存在差异。然而，输血患者较差的生存率仅在Dukes A期肿瘤患者中具有统计学意义（p<0.05）。消除年龄影响后，这种差异消失。在考虑Dukes分期、当前年龄和肿瘤部位的情况下，复发和死亡的估计风险比为1.23，95%置信区间为（0.99，1.53）。在进行充分的前瞻性研究之前，应尽可能避免输血。
