Park Yong Hyun, Kim Yong-June, Kang Seok Ho, Kim Hyeon Hoe, Byun Seok-Soo, Lee Ji Youl, Hong Sung-Hoo
1. Department of Urology, Seoul St. Mary's Hospital, The Catholic University, Seoul, Korea.
2. Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea.
J Cancer. 2016 May 12;7(8):965-72. doi: 10.7150/jca.15073. eCollection 2016.
We aimed to elucidate the association between perioperative blood transfusion (PBT) and the prognosis of patients undergoing curative surgery for renal cell carcinoma (RCC).
In all, 3,832 patients with RCC who had undergone curative surgery were included in this study from a multicenter database. PBT was defined as the transfusion of packed red blood cells within seven days before surgery, during surgery, or within the postoperative hospitalization period. The association of PBT with oncologic outcomes was evaluated using univariate and multivariate Cox regression analyses, and regression adjustment with propensity score matching.
Overall, 11.7% (447/3,832) of patients received PBT. Patients receiving PBT were significantly older at diagnosis, and had lower BMI, higher comorbidities, worse ECOG performance status, and more initial symptoms. Moreover, higher pathologic TNM stage, larger mass size, higher nuclear grade, more sarcomatoid differentiation, and more tumor necrosis were all observed more frequently in patients who received PBT. In univariate analysis, relapse-free survival, cancer-specific survival, and overall survival rates were worse in patients who received PBT; however, these factors became insignificant in the matched pairs after propensity score matching. On multivariate Cox regression analysis and regression adjustment with propensity score matching, significant prognostic effects of PBT on disease relapse, cancer-specific mortality, and all-cause mortality were not observed.
This multicenter database analysis demonstrates no significant prognostic association between PBT and oncologic outcomes in patients with RCC.
我们旨在阐明围手术期输血（PBT）与接受肾细胞癌（RCC）根治性手术患者预后之间的关联。
本研究从一个多中心数据库纳入了3832例接受过根治性手术的RCC患者。PBT定义为术前7天内、手术期间或术后住院期间输注浓缩红细胞。采用单因素和多因素Cox回归分析以及倾向得分匹配进行回归调整，评估PBT与肿瘤学结局的关联。
总体而言，11.7%（447/3832）的患者接受了PBT。接受PBT的患者诊断时年龄显著更大，BMI更低，合并症更多，ECOG体能状态更差，初始症状更多。此外，接受PBT的患者中，更高的病理TNM分期、更大的肿块大小、更高的核分级、更多的肉瘤样分化以及更多的肿瘤坏死更为常见。在单因素分析中，接受PBT的患者无复发生存率、癌症特异性生存率和总生存率更差；然而，倾向得分匹配后的配对组中这些因素变得不显著。在多因素Cox回归分析以及倾向得分匹配进行回归调整后，未观察到PBT对疾病复发、癌症特异性死亡率和全因死亡率有显著的预后影响。
这项多中心数据库分析表明，PBT与RCC患者的肿瘤学结局之间无显著的预后关联。
