Nieder Alan M, Carmack Adrienne J K, Sved Paul D, Kim Sandy S, Manoharan Murugesan, Soloway Mark S
Department of Urology, University of Miami School of Medicine, Miami, Florida 33101, USA.
Urology. 2005 Apr;65(4):730-4. doi: 10.1016/j.urology.2004.10.062.
To evaluate the risk of long-term biochemical recurrence for patients who receive cell-salvaged blood. Radical retropubic prostatectomy (RRP) is historically associated with the potential for significant blood loss. Different blood management strategies include blood donation, hemodilution, preoperative erythropoietin, and intraoperative cell salvage (IOCS). Oncologic surgeons have been reluctant to use IOCS because of the potential risk of tumor dissemination.
We retrospectively analyzed an RRP database and compared those who did and did not receive cell-salvaged blood by baseline parameters, pathologic outcomes, and biochemical recurrence. We also stratified our patients according to the risk of recurrence.
A total of 1038 patients underwent RRP between 1992 and 2003. Of these, 265 (25.5%) received cell-salvaged blood and 773 (74.5%) did not. The two groups had similar baseline characteristics. No differences were found between the two groups when compared by risk of seminal vesicle invasion or positive surgical margins. Those who received cell-salvaged blood had a lower risk of extraprostatic extension. The median follow-up for all patients was 40.2 months. The overall risk of biochemical recurrence at 5 years for those who did and did not receive cell-salvaged blood was 15% and 18%, respectively (P = 0.76). No significant differences were found in the risk of biochemical recurrence when patients were stratified according to low, intermediate, and high risk.
IOCS is a safe and effective blood management strategy for patients undergoing RRP. The risk of biochemical recurrence was not increased for those who received cell-salvaged blood. Concerns about spreading tumor cells by way of IOCS would seem unwarranted.
评估接受自体血回输的患者发生长期生化复发的风险。根治性耻骨后前列腺切除术（RRP）历来与大量失血的可能性相关。不同的血液管理策略包括献血、血液稀释、术前促红细胞生成素和术中自体血回输（IOCS）。由于存在肿瘤播散的潜在风险，肿瘤外科医生一直不愿使用IOCS。
我们回顾性分析了一个RRP数据库，并根据基线参数、病理结果和生化复发情况比较了接受和未接受自体血回输的患者。我们还根据复发风险对患者进行了分层。
1992年至2003年间共有1038例患者接受了RRP。其中，265例（25.5%）接受了自体血回输，773例（74.5%）未接受。两组的基线特征相似。在按精囊侵犯风险或手术切缘阳性进行比较时，两组之间未发现差异。接受自体血回输的患者前列腺外扩展的风险较低。所有患者的中位随访时间为40.2个月。接受和未接受自体血回输的患者5年时生化复发的总体风险分别为15%和18%（P = 0.76）。当根据低、中、高风险对患者进行分层时，生化复发风险未发现显著差异。
IOCS是一种用于接受RRP患者的安全有效的血液管理策略。接受自体血回输的患者生化复发风险并未增加。通过IOCS传播肿瘤细胞的担忧似乎没有依据。
