Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
Transfusion. 2014 Sep;54(9):2168-74. doi: 10.1111/trf.12611. Epub 2014 Mar 6.
Potential adverse effects of blood transfusion (BT) remain controversial, especially for clinical outcomes after curative cancer surgery. Some postulate that immune modulation after allogeneic BT predisposes to recurrence and death, but autologous superiority is not established. This study assessed whether BT is associated with long-term prostate cancer recurrence and survival with a large single-institutional radical prostatectomy (RP) database.
Between 1994 and 2012, a total of 11,680 patients had RP with available outcome and transfusion data. A total of 7443 (64%) had complete covariate data. Clinical variables associated with biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS) were identified with Cox proportional hazards models for three groups: no BT (reference, 27.7%, n = 2061), autologous BT only (68.8%, n = 5124), and any allogeneic BT (with or without autologous, 3.5%, n = 258).
Median (range) follow-up was 6 (1-18) years. Kaplan-Meier analysis showed significantly decreased OS (but not BRFS or PCSS) in the allogeneic group versus autologous and no BT groups (p = 0.006). With univariate analysis, any allogeneic BT had a hazard ratio (HR) of 2.29 (range, 1.52-3.46; p < 0.0001) for OS, whereas autologous BT was not significant (HR, 1.04 [range, 0.82-1.32], p = 0.752). In multivariable models, neither autologous nor allogeneic BT was independently associated with BRFS, CSS, or OS, and a dose response was not observed for allogeneic units and BRFS.
Although allogeneic but not autologous BT was associated with decreased long-term OS, after adjustment for confounding clinical variables, BT was not independently associated with OS, BRFS, or CSS regardless of transfusion type. Notably, no association was observed between allogeneic BT and cancer recurrence. Observed differences in OS may reflect confounding.
输血（BT）的潜在不良反应仍存在争议，尤其是在癌症根治性手术后的临床结果方面。一些人推测，同种异体 BT 后的免疫调节会增加复发和死亡的风险，但自体输血的优势尚未得到证实。本研究利用大型单机构根治性前列腺切除术（RP）数据库评估 BT 是否与长期前列腺癌复发和生存有关。
1994 年至 2012 年间，共有 11680 例患者接受 RP 治疗，且均有可获得的结果和输血数据。共有 7443 例（64%）具有完整的协变量数据。使用 Cox 比例风险模型，对三组患者的生化无复发生存率（BRFS）、癌症特异性生存率（CSS）和总生存率（OS）的临床变量进行识别：未输血（参考组，27.7%，n=2061）、仅自体输血（68.8%，n=5124）和任何异体输血（自体输血加或不加异体输血，3.5%，n=258）。
中位（范围）随访时间为 6（1-18）年。Kaplan-Meier 分析显示，与自体输血和未输血组相比，异体输血组的 OS 显著降低（但 BRFS 或 CSS 无差异，p=0.006）。单因素分析显示，任何异体输血的 OS 风险比（HR）为 2.29（范围 1.52-3.46；p<0.0001），而自体输血则无显著差异（HR 为 1.04，范围 0.82-1.32，p=0.752）。多变量模型中，自体输血和异体输血均与 BRFS、CSS 或 OS 无关，且未观察到异体单位与 BRFS 的剂量反应。
尽管异体输血而非自体输血与长期 OS 降低相关，但在调整混杂的临床变量后，BT 与 OS、BRFS 或 CSS 均无独立相关性，无论输血类型如何。值得注意的是，异体 BT 与癌症复发之间未观察到关联。观察到的 OS 差异可能反映了混杂因素。
