Hallet Julie, Tsang Melanie, Cheng Eva S W, Habashi Rogeh, Kulyk Iryna, Hanna Sherif S, Coburn Natalie G, Lin Yulia, Law Calvin H L, Karanicolas Paul J
Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.
Department of Surgery, University of Toronto, Toronto, ON, Canada.
Ann Surg Oncol. 2015 Nov;22(12):4038-45. doi: 10.1245/s10434-015-4477-4. Epub 2015 Mar 10.
Red blood cell transfusions (RBCTs) are associated with cancer recurrence following resection of colorectal cancer. Their impact after colorectal liver metastases (CRLM) resection remains debated. We sought to explore the association between perioperative RBCT and oncologic outcomes following resection of CRLM.
We reviewed patients undergoing partial hepatectomy for CRLM from 2003 to 2012 at a single institution. Date of death was abstracted from a validated population-based cancer registry. Primary outcome was overall survival (OS). Secondary outcome was recurrence-free survival (RFS). Survivals were estimated using Kaplan-Meier methods and compared with log-rank test based on transfusion status. Cox regression analysis examined the association of RBCT with OS and RFS, while adjusting for age, preoperative chemotherapy, Clinical Risk Score, and period of treatment (2003-2007 vs. 2008-2012).
Among 483 patients, 27.5 % received RBCT. Ninety-day postoperative mortality was 4.8 %. At median follow-up of 33 (interquartile range 20.1-54.8) months, 5-year OS was inferior in transfused patients (45.9 vs. 61.0 %; p < 0.0001). Five-year RFS was decreased with RBCT (15.5 vs. 31.6 %; p < 0.0001). The difference persisted when considering only 90-day survivors for 5-year OS (53.1 vs. 61.9 %, p = 0.023) and RFS (15.6 vs. 31.6 %; p < 0.0001). After adjustment for prognostic factors, RBCT was independently associated with decreased OS (hazard ratio 2.24; 95 % confidence interval 1.60-3.15) and RFS (hazard ratio 1.71; 95 % confidence interval 1.28-2.28).
Perioperative RBCT is independently associated with decreased OS and RFS following hepatectomy for CRLM. Interventions to minimize and rationalize the use of RBCT for hepatectomy are warranted to mitigate this detrimental effect on long-term outcomes.
红细胞输注（RBCT）与结直肠癌切除术后的癌症复发相关。其在结直肠癌肝转移（CRLM）切除术后的影响仍存在争议。我们试图探讨围手术期RBCT与CRLM切除术后肿瘤学结局之间的关联。
我们回顾了2003年至2012年在单一机构接受CRLM部分肝切除术的患者。死亡日期从经过验证的基于人群的癌症登记处提取。主要结局是总生存期（OS）。次要结局是无复发生存期（RFS）。采用Kaplan-Meier方法估计生存期，并根据输血状态通过对数秩检验进行比较。Cox回归分析在调整年龄、术前化疗、临床风险评分和治疗时期（2003 - 2007年与2008 - 2012年）后，研究RBCT与OS和RFS的关联。
483例患者中，27.5%接受了RBCT。术后90天死亡率为4.8%。在中位随访33（四分位间距20.1 - 54.8）个月时，输血患者的5年总生存期较差（45.9%对61.0%；p < 0.0001）。RBCT使5年无复发生存期降低（15.5%对31.6%；p < 0.0001）。仅考虑90天存活者的5年总生存期（53.1%对61.9%，p = 0.023）和无复发生存期（15.6%对31.6%；p < 0.0001）时，差异仍然存在。在调整预后因素后，RBCT与总生存期降低（风险比2.24；95%置信区间1.60 - 3.15）和无复发生存期降低（风险比1.71；95%置信区间1.28 - 2.28）独立相关。
围手术期RBCT与CRLM肝切除术后总生存期和无复发生存期降低独立相关。有必要采取干预措施以尽量减少并合理使用RBCT进行肝切除术，以减轻其对长期结局的有害影响。
