Panagopoulos Nikolaos D, Karakantza Marina, Koletsis Efstratios, Apostolakis Efstratios, Sakellaropoulos George C, Filos Kriton S, Eleni Theodori, Dougenis Dimitrios
Department of Cardiothoracic Surgery, University of Patras, Greece.
Lung Cancer. 2008 Nov;62(2):273-80. doi: 10.1016/j.lungcan.2008.02.025. Epub 2008 Apr 21.
It has been postulated that transfusions have immunosuppressive effects that promote tumor growth and metastasis. Moreover perioperative anemia is considered an independent prognostic factor on outcome in patients operated for malignancy. We evaluated the influence of red blood cell (RBC) transfusions and perioperative anemia on survival in non-small cell lung carcinoma (NSCLC) patients. From 1999 through 2005, 331 consecutive patients, male/female=295/36 (mean age 64+/-9 years), who underwent radical surgery for NSCLC were prospectively enrolled in this cohort and followed up for a mean of 27.2 months. The overall survival of patients was analyzed in relation to RBC transfusions and perioperative anemia. These parameters were analyzed in the whole cohort of patients and separately for stage I patients. Patients were divided according to perioperative transfusion, into Group A (transfused) and Group B (non-transfused) and according to the preoperative haemoglobin (Hb) level into Group 1(Hb<12g/dl) and Group 2(Hb> or =12g/dl), respectively. The overall transfusion rate was 25.7%. Univariate analysis showed that in the whole cohort of patients overall survival was significantly shorter in Group A (mean 33.6 months, 5-year survival 25.1%) compared to Group B (mean 48.0 months, 5-year survival 37.3%) (p=0.001). It also showed that patients with preoperative Hb level <12g/dl (Group 1), (mean of 33.0 months, 5-year survival 21.3%) had shorter survival compared to Group 2 patients (mean 49.3 months and 5-year survival 40.0%), respectively (p=0.002). Multivariate analysis in the whole cohort of patients showed that preoperative anemia was an independent risk factor for survival while RBC transfusion was not. In particular for stage I patients, it was shown that RBC transfusion was an independent prognostic factor for long-term survival as detected by multivariate analysis (p=0.043), while anemia was not. RBC transfusions affect adversely the survival of stage I NSCLC patients, while do not exert any effect on survival of patients with surgically resectable more advanced disease, where preoperative anemia is an independent negative prognostic factor. These findings indicate that RBC transfusion might exert an immunomodulatory effect on patients with early disease while in more advanced stages this effect is not apparent.
据推测，输血具有免疫抑制作用，可促进肿瘤生长和转移。此外，围手术期贫血被认为是恶性肿瘤手术患者预后的独立预测因素。我们评估了红细胞（RBC）输血和围手术期贫血对非小细胞肺癌（NSCLC）患者生存的影响。从1999年到2005年，331例连续接受NSCLC根治性手术的患者（男/女=295/36，平均年龄64±9岁）被前瞻性纳入该队列，并平均随访27.2个月。分析了患者的总生存情况与RBC输血和围手术期贫血的关系。在整个患者队列中以及分别对I期患者分析了这些参数。根据围手术期输血情况，患者分为A组（输血组）和B组（未输血组），根据术前血红蛋白（Hb）水平分别分为1组（Hb<12g/dl）和2组（Hb≥12g/dl）。总输血率为25.7%。单因素分析显示，在整个患者队列中，A组（平均33.6个月，5年生存率25.1%）的总生存期明显短于B组（平均48.0个月，5年生存率37.3%）（p=0.001）。还显示，术前Hb水平<12g/dl的患者（1组，平均33.0个月，5年生存率21.3%）的生存期短于2组患者（平均49.3个月，5年生存率40.0%）（p=0.002）。对整个患者队列的多因素分析显示，术前贫血是生存的独立危险因素，而RBC输血不是。特别是对于I期患者，多因素分析显示RBC输血是长期生存的独立预测因素（p=0.043），而贫血不是。RBC输血对I期NSCLC患者的生存有不利影响，而对手术可切除的更晚期疾病患者的生存没有任何影响，在这些患者中术前贫血是独立的不良预后因素。这些发现表明，RBC输血可能对早期疾病患者发挥免疫调节作用，而在更晚期这种作用不明显。
