Ford Beneranda S, Sharma Satish, Rezaishiraz Hamed, Huben Robert S, Mohler James L
Department of Urology, University of Buffalo School of Medicine and Biotechnology, Buffalo, NY 14203, USA.
Urol Oncol. 2008 Jul-Aug;26(4):364-7. doi: 10.1016/j.urolonc.2007.06.004. Epub 2007 Nov 7.
Transfusion may predispose patients to an increased risk of tumor recurrence following solid organ surgery. Lung and colon cancer studies suggest that blood transfusions promote tumor growth or distant metastasis possibly due to immunosuppression. Blood loss can be high during radical retropubic prostatectomy necessitating intraoperative and postoperative blood transfusion. The impact of blood transfusion on recurrence risk after radical retropubic prostatectomy remains uncertain.
To determine the influence of allogeneic or autologous blood transfusion on prostate cancer recurrence in men undergoing radical retropubic prostatectomy and assess their prognostic significance using serum prostate-specific antigen (PSA) as an intermediate endpoint.
Six hundred eleven men treated from 1987 to the present have had all clinical and follow-up data entered prospectively into a clinical database; 242 (40%) did not receive blood transfusion, 252 (41%) received autologous blood transfusion, and 117 (19%) received allogeneic blood transfusion. Biochemical failure was defined as PSA > 0.3 ng/ml on any follow-up visit. ANOVA, chi-square, and survival analyses were used to evaluate clinical characteristics and biochemical progression-free survival.
Patients participated for a mean of 44 months, range 1 to 170 months, until biochemical progression (78) or July 1, 2005 (533). Average estimated blood loss was 929 ml, 1573 ml, and 2,818 ml in the no blood transfusion, autologous blood transfusion, and allogeneic blood transfusion groups, respectively (P = 0.001). Patients in the allogeneic transfusion group were older, had higher preoperative PSA, higher stage disease, and greater blood loss. Biochemical failure rates were similar in the 3 groups (P = 0.42). Biochemical failure at 5 years occurred in 14% of men who did not receive blood transfusion, 10% of men who received autologous blood transfusion, and 16% of men who received allogeneic blood transfusion. No patient suffered clinical progression or prostate cancer death.
Autologous or allogeneic blood transfusions do not appear to influence the risk of biochemical failure in men with clinically localized prostate cancer treated with radical retropubic prostatectomy.
输血可能使实体器官手术后的患者肿瘤复发风险增加。肺癌和结肠癌研究表明，输血可能由于免疫抑制作用而促进肿瘤生长或远处转移。耻骨后根治性前列腺切除术期间失血量可能很大，因此需要术中及术后输血。输血对耻骨后根治性前列腺切除术后复发风险的影响仍不确定。
确定异体输血或自体输血对接受耻骨后根治性前列腺切除术男性患者前列腺癌复发的影响，并以血清前列腺特异性抗原（PSA）作为中间终点评估其预后意义。
1987年至今接受治疗的611名男性患者的所有临床和随访数据均已前瞻性地录入临床数据库；242例（40%）未接受输血，252例（41%）接受自体输血，117例（19%）接受异体输血。生化失败定义为任何一次随访时PSA>0.3 ng/ml。采用方差分析、卡方检验和生存分析评估临床特征和生化无进展生存期。
患者平均随访44个月，范围为1至170个月，直至出现生化进展（78例）或2005年7月1日（533例）。未输血组、自体输血组和异体输血组的平均估计失血量分别为929 ml、1573 ml和2818 ml（P = 0.001）。异体输血组患者年龄较大，术前PSA较高，疾病分期较高，失血量较大。三组的生化失败率相似（P = 0.42）。未接受输血的男性患者5年生化失败率为14%，接受自体输血的男性患者为10%，接受异体输血的男性患者为16%。无患者出现临床进展或前列腺癌死亡。
对于接受耻骨后根治性前列腺切除术治疗的临床局限性前列腺癌男性患者，自体或异体输血似乎不影响生化失败风险。
