Patil Yash J, Yakoub Mohamed, Moreno Kattia F, Cotton Colin, Tabangin Meredith E, Altaye Mekibib, Patil Reena Dhanda, Tang Alice, Zender Chad, Domack Aaron
Department of Otolaryngology Head and Neck Surgery University of Cincinnati Medical Center Cincinnati Ohio USA.
Department of Pathology and Laboratory Medicine University of Cincinnati Medical Center Cincinnati Ohio USA.
Laryngoscope Investig Otolaryngol. 2024 Jan 24;9(1):e1215. doi: 10.1002/lio2.1215. eCollection 2024 Feb.
To examine if perioperative blood transfusion affects overall survival (OS) and recurrence-free survival (RFS) in head and neck cancer patients who undergo free tissue reconstruction.
Retrospective cohort study.
The medical records of free tissue flaps between 2007 and 2010 were reviewed. Differences in demographics and clinical factors based on the level of transfused packed red blood cells (PRBC) were examined using chi-squared tests, Kruskal-Wallis tests, and/or ANOVA tests. Survival time was compared using a Cox proportional hazard model.
Data were available for 183 patients. Patients who had PRBC transfusion significantly differed from the non-transfused group by flap type, flap with bone, Charlson Comorbidity Index (CCI), and hemoglobin and hematocrit. When stratified into three groups based on units of PRBC; flap type, flap with bone, CCI, preoperative hemoglobin, and hematocrit were found to differ significantly. The 2-year Kaplan-Meier plot demonstrated improved OS for those who did not receive any PRBC transfusion. The use of more than 3 units of blood decreased 2-year OS significantly when compared to the non-transfused group. Finally, after adjusting for CCI using a Cox proportional hazard model, survival was significantly affected by CCI.
After controlling for patient age, oncologic stage, cancer subsite, histology, type of free flap, vascularized bone-containing flap, recurrence type, CCI, and preoperative hemoglobin and hematocrit, patients who received 3 or more units of PRBC in the perioperative period had significantly decreased OS. RFS did not differ between the transfused versus non-transfused groups.
Level 4.
探讨围手术期输血是否会影响接受游离组织重建的头颈癌患者的总生存期（OS）和无复发生存期（RFS）。
回顾性队列研究。
回顾2007年至2010年间游离组织瓣的病历。使用卡方检验、Kruskal-Wallis检验和/或方差分析检验，检查基于输注浓缩红细胞（PRBC）水平的人口统计学和临床因素差异。使用Cox比例风险模型比较生存时间。
有183例患者的数据可用。接受PRBC输血的患者在皮瓣类型、带骨皮瓣、Charlson合并症指数（CCI）以及血红蛋白和血细胞比容方面与未输血组有显著差异。根据PRBC单位数分为三组时，发现皮瓣类型、带骨皮瓣、CCI、术前血红蛋白和血细胞比容有显著差异。2年Kaplan-Meier曲线显示，未接受任何PRBC输血的患者OS有所改善。与未输血组相比，输注超过3单位血液显著降低了2年OS。最后，在使用Cox比例风险模型对CCI进行校正后，生存受到CCI的显著影响。
在控制患者年龄、肿瘤分期、癌症亚部位、组织学、游离皮瓣类型、含血管化骨皮瓣、复发类型、CCI以及术前血红蛋白和血细胞比容后，围手术期接受3单位或更多PRBC的患者OS显著降低。输血组和未输血组的RFS没有差异。
4级。
