Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Department of Urology, Dongguk University Ilsan Medical Center, Goyang, Korea.
Investig Clin Urol. 2020 Mar;61(2):136-145. doi: 10.4111/icu.2020.61.2.136. Epub 2020 Feb 17.
To evaluate the impact of perioperative blood transfusion (PBT) on oncologic outcomes after surgery in patients with nonmetastatic renal cell carcinoma (RCC).
This retrospective review included 2,329 patients who underwent partial or radical nephrectomy for localized RCC in a single institution from 2000 to 2014. PBT was defined as transfusion of allogeneic packed red blood cells (pRBCs) during nephrectomy or within the preoperative or postoperative hospitalization period. Oncologic outcomes of interest were recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS).
PBT was performed in 275 patients (11.8%). In the multivariable logistic regression analysis, symptomatic presentation, advanced age at surgery, higher preoperative serum creatinine, and lower preoperative hemoglobin were independent preoperative risk factors for PBT (all p<0.05). Kaplan-Meier plots revealed that transfused patients showed poorer 5-year RFS (65.1% vs. 91.2%, p<0.001), OS (71.4% vs. 92.8%, p<0.001), and CSS (74.0% vs. 95.5%, p<0.001) than nontransfused patients. However, in the multivariable Cox regression analyses, PBT was not significantly associated with RFS, OS, or CSS. In multivariable analyses involving transfused patients only (n=275), an higher number of pRBC units was an independent predictor of worse OS (hazard ratio [HR], 1.043; 95% confidence interval [CI], 1.008-1.078; p=0.016) and CSS (HR, 1.066; 95% CI, 1.033-1.100; p<0.001).
The results of this study are inconclusive in that the influence of PBT on survival outcomes could not be determined in the multivariate analysis. However, increasing pRBC units in transfused patients might be a concern in light of worse OS and CSS. Therefore, efforts to limit PBT overuse seem necessary to improve postoperative survival in patients with RCC.
评估围手术期输血（PBT）对非转移性肾细胞癌（RCC）患者手术后肿瘤学结局的影响。
本回顾性研究纳入了 2000 年至 2014 年在单家机构接受部分或根治性肾切除术治疗局限性 RCC 的 2329 例患者。PBT 定义为在肾切除术期间或术前或术后住院期间输注同种异体浓缩红细胞（pRBC）。研究关注的肿瘤学结局包括无复发生存率（RFS）、总体生存率（OS）和癌症特异性生存率（CSS）。
275 例（11.8%）患者接受了 PBT。多变量逻辑回归分析显示，有症状表现、手术时年龄较大、术前血清肌酐较高和术前血红蛋白较低是 PBT 的独立术前危险因素（均 p<0.05）。Kaplan-Meier 图显示，输血患者的 5 年 RFS（65.1% vs. 91.2%，p<0.001）、OS（71.4% vs. 92.8%，p<0.001）和 CSS（74.0% vs. 95.5%，p<0.001）均较差。然而，在多变量 Cox 回归分析中，PBT 与 RFS、OS 或 CSS 均无显著相关性。在仅纳入输血患者的多变量分析中（n=275），输注的 pRBC 单位数较多是 OS（风险比[HR]，1.043；95%置信区间[CI]，1.008-1.078；p=0.016）和 CSS（HR，1.066；95%CI，1.033-1.100；p<0.001）较差的独立预测因素。
本研究结果尚无定论，无法在多变量分析中确定 PBT 对生存结局的影响。然而，鉴于输血患者的 OS 和 CSS 较差，输注的 pRBC 单位数增加可能令人担忧。因此，为改善 RCC 患者的术后生存，似乎有必要努力限制 PBT 的过度使用。
