Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy.
Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy.
Blood Transfus. 2022 Mar;20(2):103-111. doi: 10.2450/2020.0234-20. Epub 2020 Dec 22.
Patients with colorectal cancer often present with anaemia and require red blood cell transfusions (RBCT) during their peri-operative course. Evidence suggests a significant association between RBCT and poor long-term outcomes in surgical patients, but the findings in colorectal cancer are contradictory.
The aim of this retrospective, single-centre, cohort study was to investigate the prognostic role of peri-operative RBCT in a large cohort of patients with stage I-III colorectal cancer submitted to curative surgery between 2005 and 2017. The propensity score matching technique was applied to adjust for potential confounding factors.
Among 1,414 patients operated within the study period, 895 fulfilled the inclusion criteria: 29.6% (n=265) received peri-operative RBCT. The group that received peri-operative RBCT was significantly older (p<0.001), had more comorbidities (p<0.001), more advanced tumours (p<0.001) and more colon tumours (p=0.002) and stayed in hospital longer (p<0.001). Post-operative mortality was 7-fold higher (2.3 vs 0.3%, p=0.01) in this group. Survival outcomes were significantly worse in the group receiving RBCT than in the group not receiving RBCT for both overall (64.5 vs 80.1%, p<0.001) and cancer-specific survival (74.3 vs 85.1%, p<0.001). On multivariable analysis, peri-operative RBCT was significantly associated with poorer overall survival (hazard ratio 1.51, p=0.009). When transfused and non-transfused cases were paired through the propensity score matching technique considering main clinico-pathological features, no differences in overall and cancer-specific survival were found.
Our data suggest that, after adjustment for potential confounding factors, no significant association exists between RBCT and prognosis in colorectal cancer.
结直肠癌患者常伴有贫血，并在围手术期需要输注红细胞（RBCT）。有证据表明，在接受手术治疗的患者中，RBCT 与较差的长期预后有显著关联，但在结直肠癌中的研究结果存在争议。
本回顾性单中心队列研究旨在调查在 2005 年至 2017 年间接受根治性手术治疗的 I-III 期结直肠癌患者中，围手术期 RBCT 的预后作用。应用倾向评分匹配技术来调整潜在混杂因素。
在研究期间接受手术的 1414 名患者中，895 名符合纳入标准：29.6%（n=265）接受了围手术期 RBCT。接受围手术期 RBCT 的组明显更年长（p<0.001），合并症更多（p<0.001），肿瘤更晚期（p<0.001），结肠肿瘤更多（p=0.002），住院时间更长（p<0.001）。该组的术后死亡率明显更高（2.3%比 0.3%，p=0.01）。在总生存（64.5%比 80.1%，p<0.001）和癌症特异性生存（74.3%比 85.1%，p<0.001）方面，接受 RBCT 的组的生存结果明显差于未接受 RBCT 的组。多变量分析显示，围手术期 RBCT 与总体生存不良显著相关（风险比 1.51，p=0.009）。通过倾向评分匹配技术，根据主要临床病理特征将接受输血和未接受输血的病例配对后，总生存和癌症特异性生存无差异。
我们的数据表明，在调整潜在混杂因素后，RBCT 与结直肠癌的预后之间没有显著关联。
