Blumberg N, Heal J, Chuang C, Murphy P, Agarwal M
Department of Pathology, University of Rochester Medical Center, NY 14642.
Ann Surg. 1988 Apr;207(4):410-5. doi: 10.1097/00000658-198804000-00007.
Studies of associations between perioperative blood transfusions and later recurrence of solid tumors have yielded conflicting results. A previous analysis of transfused patients suggested that recurrence was associated with transfusion of whole blood as opposed to red blood cell concentrates. Additional analyses were performed on patients with cancers of the colon, rectum, cervix, and prostate to determine if patients receiving whole blood, red blood cells only, or no transfusions had differing outcomes. Patients receiving 1 unit or more of whole blood had uniformly poor outcomes compared with nontransfused patients (p less than 0.001). In contrast, patients receiving only red blood cells had progressively worse recurrence and death rates with increasing numbers of transfusion, suggesting the presence of a dose-effect relationship. Employing multivariate techniques, blood transfusion of less than or equal to 3 units that included any whole blood were independently and significantly associated with earlier recurrence (p = 0.003) and death due to cancer (p = 0.02). Transfusions of less than or equal to 3 units of blood comprised solely of red blood cell concentrates were associated with no greater risk of recurrence than that seen in patients receiving no transfusion (p = 0.50). These results provide a potential explanation for the disparate results reported in studies of blood transfusion and cancer outcome. The marked difference in outcome seen between patients receiving a few units of red blood cells and comparable patients receiving even one unit of whole blood are consistent with the hypothesis that transfusion of stored blood plasma causes earlier tumor recurrence in some instances. Strategies for reducing these risks might include avoidance of whole blood transfusions when only 1-3 units are required, more conservative transfusion practice, use of autologous blood transfusions, and perhaps, use of red blood cells washed free of plasma and white cell debris. Clinical trials to test these hypotheses are urgently needed.
围手术期输血与实体瘤术后复发之间关联的研究结果相互矛盾。先前对输血患者的分析表明，复发与输注全血而非红细胞浓缩物有关。对患有结肠癌、直肠癌、宫颈癌和前列腺癌的患者进行了进一步分析，以确定接受全血、仅接受红细胞或未输血的患者是否有不同的预后。与未输血患者相比，接受1单位或更多全血的患者预后普遍较差（p小于0.001）。相比之下，仅接受红细胞输血的患者，随着输血量增加，复发率和死亡率逐渐升高，提示存在剂量效应关系。采用多变量技术分析发现，输注少于或等于3单位且包含任何全血的输血与较早复发（p = 0.003）和癌症死亡（p = 0.02）独立且显著相关。仅由红细胞浓缩物组成的少于或等于3单位的输血与未输血患者相比，复发风险并无增加（p = 0.50）。这些结果为输血与癌症预后研究中报道的不同结果提供了一个可能的解释。接受几单位红细胞输血的患者与接受哪怕1单位全血的类似患者之间明显的预后差异，与储存血浆输血在某些情况下会导致肿瘤早期复发的假设一致。降低这些风险的策略可能包括，在仅需要1 - 3单位输血时避免输注全血、采用更保守的输血做法、使用自体输血，或许还可使用去除血浆和白细胞碎片的洗涤红细胞。迫切需要进行临床试验来验证这些假设。
