Tsivian Matvey, Abern Michael R, Tsivian Efrat, Sze Christina, Jibara Ghalib, Rampersaud Edward N, Polascik Thomas J
Department of Surgery, Duke University Medical Center, Duke Cancer Institute, Durham, NC.
Department of Surgery, Duke University Medical Center, Duke Cancer Institute, Durham, NC; Department of Urology, University of Illinois, Chicago, IL.
Urol Oncol. 2018 Aug;36(8):362.e1-362.e7. doi: 10.1016/j.urolonc.2018.04.014. Epub 2018 May 21.
To assess the associations between perioperative allogeneic blood transfusions (ABTs) and recurrence, overall and renal cell carcinoma (RCC)-specific survival in patients undergoing surgical treatment for clinically localized disease.
We performed a retrospective review of 1,056 consecutive patients undergoing surgical treatment (radical or partial nephrectomy) for clinically localized RCC between 2000 to 2010. Demographic (age, race, and sex) clinical (preoperative hemoglobin and hematocrit, type of surgery [partial or radical nephrectomy]), and pathological (T and N stages, RCC histotype, grade) data were compared between patients receiving perioperative (intraoperative or postoperative) blood transfusions and those who are not. Distant and local recurrence-free survival, overall survival, RCC-specific survival were recorded and Kaplan-Meier survival curves as well as multivariable proportional regression models adjusted for clinical and pathological characteristics were produced.
On multivariable analyses adjusted for clinical and pathological characteristics, the receipt of ABTs was associated with lower recurrence-free (HR = 1.86, P = 0.002), overall (HR = 1.83, P = 0.016), and RCC-specific survival (HR = 2.12, P = 0.031). The negative effect of ABTs was apparent for distant (HR = 2.24, P<0.001) but not local recurrences (HR = 0.78, P = 0.643). Limitations include retrospective nature and lack of uniform criteria for blood transfusion during the study period.
In this study, perioperative ABTs were independently associated with worse oncological outcomes in patients with clinically localized RCC. Receipt of ABT was associated with roughly a 2-fold increase in the hazard of metastatic progression, all-cause and RCC-specific mortality. Further research is needed on the mechanisms of transfusion-induced immunomodulation, alternative transfusion protocols and methods for autologous blood transfusion and recovery.
评估围手术期异体输血（ABT）与接受临床局限性疾病手术治疗患者的复发、总生存率及肾细胞癌（RCC）特异性生存率之间的关联。
我们对2000年至2010年间连续1056例接受临床局限性RCC手术治疗（根治性或部分肾切除术）的患者进行了回顾性研究。比较了接受围手术期（术中或术后）输血患者与未输血患者的人口统计学（年龄、种族和性别）、临床（术前血红蛋白和血细胞比容、手术类型[部分或根治性肾切除术]）及病理（T和N分期、RCC组织学类型、分级）数据。记录远处和局部无复发生存率、总生存率、RCC特异性生存率，并绘制Kaplan-Meier生存曲线以及针对临床和病理特征进行调整的多变量比例回归模型。
在针对临床和病理特征进行调整的多变量分析中，接受ABT与较低的无复发生存率（HR = 1.86，P = 0.002）、总生存率（HR = 1.83，P = 0.016）及RCC特异性生存率（HR = 2.12，P = 0.031）相关。ABT的负面影响在远处复发（HR = 2.24，P<0.001）中明显，但在局部复发中不明显（HR = 0.78，P = 0.643）。局限性包括研究的回顾性性质以及研究期间输血缺乏统一标准。
在本研究中，围手术期ABT与临床局限性RCC患者较差的肿瘤学结局独立相关。接受ABT与转移进展、全因死亡率和RCC特异性死亡率的风险增加约2倍相关。需要进一步研究输血诱导免疫调节的机制、替代输血方案以及自体输血和恢复方法。
