围手术期输注浓缩红细胞对上皮性卵巢癌患者生存的影响。
The impact of perioperative packed red blood cell transfusion on survival in epithelial ovarian cancer.
机构信息
*Mayo Medical School, †Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, ‡Department of Surgical Clinical Research, and §Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
出版信息
Int J Gynecol Cancer. 2013 Nov;23(9):1612-9. doi: 10.1097/01.IGC.0000436089.03581.6b.
OBJECTIVE
Perioperative packed red blood cell transfusion (PRBCT) has been implicated as a negative prognostic marker in surgical oncology. There is a paucity of evidence on the impact of PRBCT on outcomes in epithelial ovarian cancer (EOC). We assessed whether PRBCT is an independent risk factor of recurrence and death from EOC.
METHODS
Perioperative patient characteristics and process-of-care variables (defined by the National Surgical Quality Improvement Program) were retrospectively abstracted from 587 women who underwent primary EOC staging between January 2, 2003, and December 29, 2008. Associations with receipt of PRBCT were evaluated using univariate logistic regression models. The associations between receipt of PRBCT and disease-free survival and overall survival were evaluated using multivariable Cox proportional hazards models and using propensity score matching and stratification, respectively.
RESULTS
The rate of PRBCT was 77.0%. The mean ± SD units transfused was 4.1 ± 3.1 U. In the univariate analysis, receipt of PRBCT was significantly associated with older age, advanced stage (≥ IIIA), undergoing splenectomy, higher surgical complexity, serous histologic diagnosis, greater estimated blood loss, longer operating time, the presence of residual disease, and lower preoperative albumin and hemoglobin. Perioperative packed red blood cell transfusion was not associated with an increased risk for recurrence or death, in an analysis adjusting for other risk factors in a multivariable model or in an analysis using propensity score matching or stratification to control for differences between the patients with and without PRBCT.
CONCLUSIONS
Perioperative packed red blood cell transfusion does not seem to be directly associated with recurrence and death in EOC. However, lower preoperative hemoglobin was associated with a higher risk for recurrence. The need for PRBCT seems to be a stronger prognostic indicator than the receipt of PRBCT.
目的
围手术期输注浓缩红细胞（PRBCT）已被认为是外科肿瘤学中预后不良的标志。关于 PRBCT 对上皮性卵巢癌（EOC）结局的影响，证据有限。我们评估了 PRBCT 是否是 EOC 复发和死亡的独立危险因素。
方法
回顾性地从 2003 年 1 月 2 日至 2008 年 12 月 29 日接受初次 EOC 分期的 587 名女性患者中提取围手术期患者特征和手术过程变量（由国家外科质量改进计划定义）。使用单变量逻辑回归模型评估接受 PRBCT 的相关性。使用多变量 Cox 比例风险模型和倾向评分匹配和分层分别评估接受 PRBCT 与无病生存和总生存之间的相关性。
结果
PRBCT 的使用率为 77.0%。输注的平均±SD 单位为 4.1±3.1U。在单变量分析中，接受 PRBCT 与年龄较大、晚期（≥IIIA）、行脾切除术、手术难度较高、浆膜组织学诊断、估计出血量较大、手术时间较长、存在残余疾病以及术前白蛋白和血红蛋白水平较低显著相关。在多变量模型中调整其他危险因素或使用倾向评分匹配或分层控制接受和未接受 PRBCT 的患者之间的差异后，围手术期输注浓缩红细胞与复发或死亡风险增加无关。
结论
围手术期输注浓缩红细胞似乎与 EOC 的复发和死亡没有直接关系。然而，较低的术前血红蛋白与更高的复发风险相关。PRBCT 的需求似乎比接受 PRBCT 更能预测预后。
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