Reeh Matthias, Ghadban Tarik, Dedow Josephine, Vettorazzi Eik, Uzunoglu Faik G, Nentwich Michael, Kluge Stefan, Izbicki Jakob R, Vashist Yogesh K
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Department of Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
World J Surg. 2017 Jan;41(1):208-215. doi: 10.1007/s00268-016-3730-8.
Esophageal resection for cancer (EC) is still associated with considerable mortality and morbidity rates. Allogenic blood transfusion (aBT) is associated with poor short-term and long-term outcome in surgical oncology. We aimed to evaluate the effect of aBT in a homogeneous population of EC patients undergoing esophagectomy without perioperative treatment.
We analyzed 565 esophagectomies performed due to EC. Allogenic blood transfusion was correlated to clinicopathological parameters, perioperative mortality and morbidity as well as the long-term outcome. Results are presented as adjusted odds ratio (OR) or hazard ratio (HR) with 95 % confidence interval (95 % CI).
Patients receiving aBT (aBT(+)) had no higher tumor stages or higher rates of lymph node metastasis (P = 0.65 and 0.17, respectively) compared to patients without aBT (aBT(-)). Allogenic blood transfusion was strongly associated with perioperative morbidity (OR 1.9, 95 % CI 1.1-3.5, P = 0.02) and mortality (OR 2.9, 95 % CI 1.0-8.6, P = 0.04). Tumor recurrence rate was significantly higher in aBT(+) patients (P = 0.001). The disease-free and overall survival were significantly longer in aBT(-) compared to aBT(+) patients (P = 0.016 and <0.001, respectively). Patients receiving aBT had almost doubled risk for tumor recurrence (HR 1.8, 95 % CI 1.2-2.5, P = 0.001) and death (HR 2.2, 95 % CI 1.5-3.2, P < 0.001).
Allogenic blood transfusion has a significant impact on the natural course of EC after complete resection. The poor short-term and long-term outcome warrants further evaluation of the underlying molecular mechanisms induced by allogenic blood transfusion in cancer patients.
食管癌切除术（EC）的死亡率和发病率仍然较高。异体输血（aBT）与外科肿瘤学的短期和长期不良预后相关。我们旨在评估aBT对一组未经围手术期治疗的接受食管切除术的EC患者的影响。
我们分析了565例因EC进行的食管切除术。将异体输血与临床病理参数、围手术期死亡率和发病率以及长期预后进行关联分析。结果以调整后的比值比（OR）或风险比（HR）及95%置信区间（95%CI）表示。
与未接受aBT（aBT（-））的患者相比，接受aBT（aBT（+））的患者肿瘤分期和淋巴结转移率均无更高（分别为P = 0.65和0.17）。异体输血与围手术期发病率（OR 1.9，95%CI 1.1 - 3.5，P = 0.02）和死亡率（OR 2.9，95%CI 1.0 - 8.6，P = 0.04）密切相关。aBT（+）患者的肿瘤复发率显著更高（P = 0.001）。与aBT（+）患者相比，aBT（-）患者的无病生存期和总生存期显著更长（分别为P = 0.016和<0.001）。接受aBT的患者肿瘤复发风险几乎翻倍（HR 1.8，95%CI 1.2 - 2.5，P = 0.001），死亡风险也几乎翻倍（HR 2.2，95%CI 1.5 - 3.2，P < 0.001）。
异体输血对EC完全切除后的自然病程有显著影响。其短期和长期不良预后值得进一步评估癌症患者异体输血所诱导的潜在分子机制。
