Little A G, Wu H S, Ferguson M K, Ho C H, Bowers V D, Segalin A, Staszek V M
Department of Surgery, University of Nevada School of Medicine, Las Vegas 89102.
Am J Surg. 1990 Dec;160(6):630-2; discussion 633. doi: 10.1016/s0002-9610(05)80762-7.
It has been speculated that blood transfusion might adversely affect prognosis in cancer patients by immunosuppression. To avoid the confounding affect of advanced disease, we tested this hypothesis in 117 patients with stage I non-small-cell lung cancer. Mean and median follow-up were 49.7 months and 47 months, respectively. Patients who died during the postoperative period were not included. Perioperative transfusion was defined as administration of whole blood or packed cells within 30 days of operation. The overall cumulative 5-year disease-free survival rate was 67%. In patients with transfusion, it was 53% and in patients without transfusion it was 81% (p = 0.0055). A multivariate analysis was performed that included patient age, race, sex, cell type, extent of operation (pneumonectomy versus lobectomy/segmentectomy), operative blood loss, admission hematocrit, discharge hematocrit, and the presence or absence of perioperative transfusion. The only variable that significantly correlated with 5-year disease-free survival was the presence or absence of perioperative transfusion (p = 0.0278), and this effect was not related to the number of transfusions. Retrospective analysis of long-term results of patients surviving curative operation for stage I lung cancer shows that any perioperative transfusion significantly worsens the patient's prognosis and suggests very strongly that this association is due to an adverse effect of the transfusion rather than the transfusion serving as a marker for another risk factor.
据推测，输血可能通过免疫抑制对癌症患者的预后产生不利影响。为避免晚期疾病的混杂影响，我们在117例I期非小细胞肺癌患者中验证了这一假设。平均随访时间和中位随访时间分别为49.7个月和47个月。术后死亡的患者未纳入研究。围手术期输血定义为在手术30天内输注全血或红细胞悬液。总体累积5年无病生存率为67%。输血患者的5年无病生存率为53%，未输血患者为81%（p = 0.0055）。进行了多因素分析，纳入了患者年龄、种族、性别、细胞类型、手术范围（全肺切除术与肺叶切除术/肺段切除术）、术中失血量、入院时血细胞比容、出院时血细胞比容以及围手术期是否输血。与5年无病生存率显著相关的唯一变量是围手术期是否输血（p = 0.0278），且这种影响与输血量无关。对I期肺癌根治性手术后存活患者的长期结果进行回顾性分析表明，任何围手术期输血都会显著恶化患者的预后，并强烈提示这种关联是由于输血的不利影响，而非输血作为另一个危险因素的标志物。
