Woolley A L, Hogikyan N D, Gates G A, Haughey B H, Schechtman K B, Goldenberg J L
Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri.
Ann Otol Rhinol Laryngol. 1992 Sep;101(9):724-30. doi: 10.1177/000348949210100902.
To study the effect of transfusion on recurrence of squamous cell carcinoma of the head and neck, we analyzed the records of 143 patients with stage II through IV squamous cell carcinoma of the supraglottic larynx or hypopharynx for whom follow-up to recurrence or 5 years after surgical therapy was available. Variables studied were age, gender, TNM staging, duration of operation, estimated blood loss, units of blood products transfused, surgical margins, number of pathologic nodes, radiotherapy, chemotherapy, hematocrit, and serum albumin. Multivariate logistic regression demonstrated that transfusion, number of pathologic nodes, and preoperative hematocrit were significantly related to recurrence. The univariate odds ratio for tumor recurrence in patients receiving any blood products was 3.2 (95% confidence interval 1.5 to 6.9; p = .004). Based on a meta-analysis of the data from this study and the five published studies, the combined odds ratio for recurrence after transfusion was 2.6 (95% confidence interval 1.9 to 3.7; p less than .0001). These data identify a clinically important adverse effect of transfusion of blood products on tumor recurrence in patients with advanced head and neck cancer. We recommend a policy of blood conservation surgery to enhance cancer control, and we encourage further research to clarify the mechanism(s) of this effect.
为研究输血对头颈部鳞状细胞癌复发的影响，我们分析了143例声门上喉或下咽II至IV期鳞状细胞癌患者的记录，这些患者有术后复发或随访5年的数据。研究的变量包括年龄、性别、TNM分期、手术时长、估计失血量、输注血制品的单位数、手术切缘、病理淋巴结数量、放疗、化疗、血细胞比容和血清白蛋白。多因素逻辑回归分析显示，输血、病理淋巴结数量和术前血细胞比容与复发显著相关。接受任何血制品的患者肿瘤复发的单因素比值比为3.2（95%置信区间1.5至6.9；p = 0.004）。基于对本研究数据和五项已发表研究的荟萃分析，输血后复发的合并比值比为2.6（95%置信区间1.9至3.7；p < 0.0001）。这些数据表明，输注血制品对晚期头颈癌患者的肿瘤复发具有临床上重要的不良影响。我们建议采取血液保护手术策略以加强癌症控制，并鼓励进一步研究以阐明这种影响的机制。
