Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Clinical Research Institute, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
World J Surg. 2019 Nov;43(11):2894-2901. doi: 10.1007/s00268-019-05085-w.
Whether perioperative allogeneic blood transfusion (PABT) negatively influences patient survival after hepatectomy (HR) for hepatocellular carcinoma (HCC) remains controversial.
Five hundred two patients who underwent HR for initial HCC between 1994 and 2015 were enrolled in this study. All patients were divided into two groups: the PABT group and the non-PABT group. Differences of clinicopathological factors, overall survival (OS), recurrence-free survival (RFS), and the recurrence pattern between the two groups were evaluated. Using propensity score matching for tumor-related factors, liver functions, and surgical factors (total 11 factors), the survival impact of PABT was also analyzed.
In the entire cohort, 78 patients (15.5%) received PABT such as red cell concentrate, fresh-frozen plasma, or platelets. OS (5-year OS: 55% vs. 76%; p = 0.0005) and RFS (2-year RFS: 47% vs. 56%; p = 0.0131) were significantly worse in the PABT group. The extrahepatic recurrence happened more frequently in the PABT group (15% vs. 5.4%; p = 0.0039). There were many significant clinicopathological differences between the two groups: more advanced tumor stage (tumor diameter, stage III or IV, microvascular invasion), worse liver functions (albumin, indocyanine green retention rate at 15 min), and more surgical stress (blood loss, operation time) in the PABT group. After propensity score matching, 43 pairs of patients were extracted. In this matched cohort, the survival curves of the PABT and non-PABT groups almost completely overlapped both in OS (5-year OS: 62% vs. 62%; p = 0.4384) and in RFS (2-year RFS: 49% vs. 47%; p = 0.8195). The significant difference of the extrahepatic recurrence rate disappeared in the matched cohort (p = 0.5789).
Using propensity score matching, we found that PABT does not influence patient survival after HR for HCC.
围手术期异体输血（PABT）是否会对肝细胞癌（HCC）患者行肝切除术（HR）后的生存产生负面影响仍存在争议。
本研究纳入了 1994 年至 2015 年间接受 HR 治疗的 502 例初诊 HCC 患者。所有患者均分为 PABT 组和非 PABT 组。评估两组间临床病理因素、总生存（OS）、无复发生存（RFS）和复发模式的差异。采用倾向评分匹配肿瘤相关因素、肝功能和手术因素（共 11 个因素），分析 PABT 对生存的影响。
在整个队列中，78 例（15.5%）患者接受了 PABT，如浓缩红细胞、新鲜冷冻血浆或血小板。PABT 组的 OS（5 年 OS：55%比 76%；p=0.0005）和 RFS（2 年 RFS：47%比 56%；p=0.0131）明显较差。PABT 组更易发生肝外复发（15%比 5.4%；p=0.0039）。两组间存在许多显著的临床病理差异：PABT 组肿瘤分期更晚（肿瘤直径、III 或 IV 期、微血管侵犯），肝功能更差（白蛋白、15 分钟吲哚菁绿滞留率），手术应激更大（出血量、手术时间）。在倾向评分匹配后，提取了 43 对患者。在匹配队列中，PABT 组和非 PABT 组的生存曲线在 OS（5 年 OS：62%比 62%；p=0.4384）和 RFS（2 年 RFS：49%比 47%；p=0.8195）方面几乎完全重叠。匹配队列中肝外复发率的显著差异消失（p=0.5789）。
采用倾向评分匹配，我们发现 PABT 并不影响 HCC 患者 HR 后的生存。
