Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Er Road, Guangzhou, 510080, China.
Department of Operating Center, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Er Road, Guangzhou, 510080, China.
BMC Cancer. 2020 May 29;20(1):487. doi: 10.1186/s12885-020-06980-5.
The influence of perioperative blood transfusion (PBT) on postsurgical survival of patients with different stage of hepatocellular carcinoma (HCC) is not well clarified. This study aimed to evaluate the impact of PBT on survival outcomes of different stage of HCC patients.
Consecutive patients who underwent liver resection for HCC between January 2009 and November 2015 were identified from an HCC prospective database in authors' center. The survival outcomes were compared between patients receiving PBT and those without PBT before and after propensity score matching (PSM) in different stage subsets. Cox regression analysis was performed to verify the impact of PBT on outcomes of HCC.
Among 1255 patients included, 804 (64.1%) were Barcelona Clinic Liver Cancer (BCLC) stage 0-A, and 347 (27.6%) received PBT. Before PSM, patients with PBT had worse disease free survival (DFS) and overall survival (OS) compared with those without PBT in both BCLC 0-A subset and BCLC B-C subset (all P < 0.05). After PSM, 288 pairs of patients (with and without PBT) were created. In the subset of BCLC 0-A, the median DFS of patients with PBT was shorter than those without PBT (12.0 months vs. 36.0 months, P = 0.001) Similar result was observed for OS (36.0 months vs. 96.0 months, P = 0.001). In the subset of BCLC B-C, both DFS and OS were comparable between patients with PBT and those without PBT. Cox regression analysis showed that PBT involved an increasing risk of DFS (HR = 1.607; P < 0.001) and OS (HR = 1.756; P < 0.001) for this subset. However, PBT had no impact on DFS (P = 0.126) or OS (P = 0.139) for those with stage B-C HCC.
PBT negatively influenced oncologic outcomes of patient with BCLC stage 0-A HCC, but not those with stage B-C after curative resection.
围手术期输血（PBT）对不同分期肝细胞癌（HCC）患者术后生存的影响尚不清楚。本研究旨在评估 PBT 对不同分期 HCC 患者生存结局的影响。
从作者中心的 HCC 前瞻性数据库中确定了 2009 年 1 月至 2015 年 11 月期间接受肝切除术治疗 HCC 的连续患者。在不同分期亚组中，在进行倾向评分匹配（PSM）前后，比较接受 PBT 和未接受 PBT 的患者的生存结局。采用 Cox 回归分析验证 PBT 对 HCC 结局的影响。
在纳入的 1255 例患者中，804 例（64.1%）为巴塞罗那临床肝癌（BCLC）分期 0-A，347 例（27.6%）接受了 PBT。在 PSM 之前，与未接受 PBT 的患者相比，接受 PBT 的患者在 BCLC 0-A 亚组和 BCLC B-C 亚组中的无病生存（DFS）和总生存（OS）均较差（均 P<0.05）。PSM 后，创建了 288 对（接受和未接受 PBT）患者。在 BCLC 0-A 亚组中，接受 PBT 的患者的中位 DFS 短于未接受 PBT 的患者（12.0 个月 vs. 36.0 个月，P=0.001），OS 也类似（36.0 个月 vs. 96.0 个月，P=0.001）。在 BCLC B-C 亚组中，接受 PBT 的患者的 DFS 和 OS 与未接受 PBT 的患者无差异。Cox 回归分析显示，对于该亚组，PBT 与 DFS（HR=1.607；P<0.001）和 OS（HR=1.756；P<0.001）的风险增加相关。然而，PBT 对 BCLC 期 B-C HCC 患者的 DFS（P=0.126）或 OS（P=0.139）无影响。
PBT 对 BCLC 分期 0-A HCC 患者的肿瘤学结局产生负面影响，但对接受根治性切除的 BCLC 分期 B-C HCC 患者则没有影响。
