Blumberg N, Heal J M, Murphy P, Agarwal M M, Chuang C
Br Med J (Clin Res Ed). 1986 Aug 30;293(6546):530-3. doi: 10.1136/bmj.293.6546.530.
Transfusion affects the immune response to renal transplantation and may be associated with recurrence of various human neoplasms. Data from patients with colonic, rectal, cervical, and prostate tumours showed an association between transfusion of any amount of whole blood or larger amounts of red blood cells at the time of surgery and later recurrence of cancer. Recipients of one unit of whole blood had a significantly higher incidence of recurrence (45%) than recipients of a single unit of red cells (12%) (p = 0.03). Recipients of two units of whole blood also had a higher rate of recurrence (52%) than those receiving two units of red cells (23%) (p = 0.03). Recipients of any amount of whole blood had similar recurrence rates (38-52%). Recipients of four or more units of red blood cells had a higher rate of recurrence (55%) than those receiving three or fewer units of red blood cells (20%) (p = 0.005). Mortality due to cancer in patients receiving three or fewer units of red blood cells (2%) was similar to that in patients who did not have transfusions (7%) and significantly lower than that observed in patients receiving three or fewer units of whole blood (20%) (p = 0.003). A proportional hazards risk analysis showed that transfusion of any whole blood or more than three units of red blood cells was significantly associated with earlier recurrence and death due to cancer. These data support an association between transfusion and recurrence of cancer. They also suggest that some factor present in greater amounts in whole blood, such as plasma, may contribute to the increased risk of recurrence in patients who have undergone transfusion. Until the questions raised by retrospective studies of cancer recurrence and transfusion can be answered by prospective interventional trials with washed red blood cells, red blood cells should be transfused to patients with cancer in preference to whole blood when clinically feasible.
输血会影响肾移植的免疫反应，并且可能与多种人类肿瘤的复发有关。来自患有结肠、直肠、宫颈和前列腺肿瘤患者的数据显示，手术时输注任何量的全血或大量红细胞与癌症后期复发之间存在关联。接受一单位全血的患者复发率（45%）显著高于接受一单位红细胞的患者（12%）（p = 0.03）。接受两单位全血的患者复发率（52%）也高于接受两单位红细胞的患者（23%）（p = 0.03）。接受任何量全血的患者复发率相似（38 - 52%）。接受四单位或更多单位红细胞的患者复发率（55%）高于接受三单位或更少单位红细胞的患者（20%）（p = 0.005）。接受三单位或更少单位红细胞的患者因癌症导致的死亡率（2%）与未输血患者的死亡率（7%）相似，且显著低于接受三单位或更少单位全血的患者（20%）（p = 0.003）。比例风险分析表明，输注任何全血或超过三单位红细胞与癌症早期复发和死亡显著相关。这些数据支持输血与癌症复发之间的关联。它们还表明，全血中含量更高的某些因素，如血浆，可能会增加输血患者的复发风险。在通过使用洗涤红细胞的前瞻性干预试验回答癌症复发与输血的回顾性研究所提出的问题之前，在临床可行的情况下，应优先为癌症患者输注红细胞而非全血。
