Fenner Matthias, Vairaktaris Eleftherios, Nkenke Emeka, Weisbach Volker, Neukam Friedrich W, Radespiel-Tröger Martin
Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
Cancer. 2009 Apr 1;115(7):1481-8. doi: 10.1002/cncr.24132.
The objective of this study was to assess the impact of perioperative transfusion on the prognosis of patients who underwent complete (R0) resection of oral squamous cell carcinoma and reconstruction by microvascular flaps.
By following an inclusion and exclusion protocol, 223 patients were included in the study who underwent R0 resection of oral squamous cell carcinoma and reconstruction by microvascular flaps at a single center. Clinical and pathologic factors as well as transfusion data were retrieved from a prospective database and analyzed retrospectively. Survival data were assessed using the method of Kaplan and Meier. For multivariate analysis the accelerated failure time model (Weibull distribution) was chosen.
The overall survival rate was 71% at 1 year, 67% at 3 years, and 55% at 5 years. In univariate analysis, age (P = .003), tumor size (P = .005), lymph node status (P = .008), tumor differentiation (P = .008), transfusion (P = .006), American Society of Anesthesiologists (ASA) class (P = .001), and mandibular reconstruction (P = .045) were associated significantly with overall survival. Multivariate analysis identified only age, histopathologic differentiation, and ASA class as independent risk factors (P < .001, P = .04, and P = .049, respectively). Age was identified as the strongest independent predictor for overall survival (hazards ratio for each 13-year increase in age, 1.97; 95% confidence interval, 1.36-2.85).
Transfusion of >4 U of blood did not appear to influence overall survival in patients who underwent primary surgery for oral squamous cell carcinoma. Because age and ASA class evolved as the strongest predictors of shortened overall survival, associated comorbidities may require more attention, particularly in elderly or socially deprived patients.
本研究的目的是评估围手术期输血对接受口腔鳞状细胞癌根治性（R0）切除并采用微血管皮瓣重建患者预后的影响。
按照纳入和排除标准，本研究纳入了223例在单一中心接受口腔鳞状细胞癌R0切除并采用微血管皮瓣重建的患者。从前瞻性数据库中检索临床和病理因素以及输血数据，并进行回顾性分析。采用Kaplan-Meier方法评估生存数据。多变量分析选择加速失效时间模型（威布尔分布）。
1年总生存率为71%，3年为67%，5年为55%。单变量分析中，年龄（P = .003）、肿瘤大小（P = .005）、淋巴结状态（P = .008）、肿瘤分化（P = .008）、输血（P = .006）、美国麻醉医师协会（ASA）分级（P = .001）和下颌骨重建（P = .045）与总生存显著相关。多变量分析仅确定年龄、组织病理学分化和ASA分级为独立危险因素（分别为P < .001、P = .04和P = .049）。年龄被确定为总生存最强的独立预测因素（年龄每增加13岁的风险比为1.97；95%置信区间为1.36 - 2.85）。
对于接受口腔鳞状细胞癌初次手术的患者，输注超过4单位血液似乎并未影响总生存。由于年龄和ASA分级是总生存缩短的最强预测因素，相关合并症可能需要更多关注，尤其是老年或社会经济条件差的患者。
