Bednarsch Jan, Czigany Zoltan, Heij Lara R, Luedde Tom, Loosen Sven H, Dulk Marcel den, Bruners Philipp, Lang Sven A, Ulmer Tom F, Neumann Ulf P
Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.
Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany; Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany.
Eur J Surg Oncol. 2022 Mar;48(3):604-614. doi: 10.1016/j.ejso.2021.09.011. Epub 2021 Sep 20.
Major hepatectomy for perihilar and intrahepatic cholangiocarcinoma (CCA) is often associated with a significant intraoperative blood loss and the requirement for perioperative transfusion of blood products. The aim of this study was to investigate the oncological impact of fresh frozen plasma (FFP) transfusion during hospitalization in patients undergoing hepatectomy for CCA as adverse effects have been described in other malignancies.
Patients undergoing hepatectomy for CCA from 2010 to 2019 at a single institution were eligible for this study. Survival analysis was carried out according to Kaplan-Meier and the associations of cancer-specific (CSS) and recurrence-free survival (RFS) with in-hospital application of FFP and other clinico-pathological characteristics were assessed using Cox regression models. Perioperatively deceased patients were excluded from the analysis.
A total of 219 CCA patients were included in this survival analysis of which 53.0% (116/219) received FFP during hospitalization. Patients receiving in-hospital FFP showed a median CCS of 33 months (3-year-CSS = 46%, 5-year-CSS = 29%) compared to 83 months (3-year-CSS = 55%, 5-year-CSS = 53%) in patients who did not receive in-hospital FFP (p = 0.006 log rank). Further, in-hospital FFP was identified as an independent predictor of oncological outcome in multivariable analysis (CSS: HR = 1.71, p = 0.016; RFS: HR = 1.89, p = 0.003).
In a large European cohort of patients, in-hospital transfusion of FFP was identified as a novel independent prognostic marker in CCA patients undergoing curative-intent liver surgery. A restrictive transfusion policy is therefore recommended to improve long-term outcome in these patients.
肝门部及肝内胆管癌（CCA）的大肝切除术常伴随着术中大量失血以及围手术期对血液制品输血的需求。本研究的目的是调查接受CCA肝切除术的患者住院期间输注新鲜冰冻血浆（FFP）对肿瘤学的影响，因为在其他恶性肿瘤中已描述了其不良反应。
2010年至2019年在单一机构接受CCA肝切除术的患者符合本研究条件。根据Kaplan-Meier法进行生存分析，并使用Cox回归模型评估癌症特异性生存（CSS）和无复发生存（RFS）与住院期间FFP应用及其他临床病理特征的相关性。围手术期死亡患者被排除在分析之外。
本生存分析共纳入219例CCA患者，其中53.0%（116/219）在住院期间接受了FFP。接受住院FFP的患者CSS中位数为33个月（3年CSS = 46%，5年CSS = 29%），而未接受住院FFP的患者为83个月（3年CSS = 55%，5年CSS = 53%）（对数秩检验p = 0.006）。此外，在多变量分析中，住院FFP被确定为肿瘤学结局的独立预测因素（CSS：HR = 1.71，p = 0.016；RFS：HR = 1.89，p = 0.003）。
在一个大型欧洲患者队列中，住院期间输注FFP被确定为接受根治性肝手术的CCA患者的一种新的独立预后标志物。因此，建议采取限制性输血策略以改善这些患者的长期结局。
