Department of Surgery, School of Clinical Medicine, University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
Langenbecks Arch Surg. 2024 Mar 4;409(1):83. doi: 10.1007/s00423-024-03278-z.
This study is to examine the impact of perioperative (intraoperative/postoperative) blood transfusion on the outcomes of curative hepatectomy for hepatocellular carcinoma. Hepatectomy is a well-established curative treatment for hepatocellular carcinoma, and blood transfusion cannot always be avoided in treating the disease.
A retrospective study of patients having curative hepatectomy for hepatocellular carcinoma from January 2010 to December 2019 at a single center was conducted. The patients were stratified by their disease stage. Patients with and without perioperative blood transfusion were matched by propensity-score matching and compared for each disease stage. Univariate and multivariate analyses were performed to identify prognostic factors for overall survival for each stage.
A total of 846 patients were studied. Among them, 125 received perioperative blood transfusion and 720 did not. Patients with blood transfusion had worse disease-free and overall survival. After stratification and matching, the ratios of transfusion to non-transfusion were 33:165 (stage 1), 28:140 (stage 2), and 45:90 (stage 3). Perioperative blood transfusion was associated with a higher incidence of postoperative complications in all three disease stages (p = 0.004/0.006/0.017), and hence longer hospitalization (p < 0.001 in all stages), but had no significant impact on hospital mortality (p = 0.119/0.118/0.723), 90-day mortality (p = 0.259/0.118/0.723), disease-free survival (p = 0.128/0.826/0.511), or overall survival (p = 0.869/0.122/0.122) in any disease stage. Prognostic factors for overall survival included tumor size, tumor number, alpha-fetoprotein level, and postoperative complication of grade ≥ 3A.
Perioperative blood transfusion was associated with a higher incidence of complications but had no significant impact on survival after curative hepatectomy for hepatocellular carcinoma.
本研究旨在探讨围手术期（术中/术后）输血对肝细胞癌根治性肝切除术疗效的影响。肝切除术是治疗肝细胞癌的一种成熟的根治性治疗方法，在治疗该病时并不总能避免输血。
对 2010 年 1 月至 2019 年 12 月在一家单中心接受根治性肝切除术治疗肝细胞癌的患者进行回顾性研究。根据疾病分期对患者进行分层。通过倾向评分匹配比较有和无围手术期输血的患者，并对每个疾病分期进行比较。对每个分期进行单因素和多因素分析，以确定总生存率的预后因素。
共研究了 846 例患者。其中 125 例接受围手术期输血，720 例未输血。输血患者的无病生存率和总生存率较差。分层和匹配后，输血与非输血的比例分别为 33:165（I 期）、28:140（II 期）和 45:90（III 期）。围手术期输血与所有三个疾病阶段的术后并发症发生率较高相关（p=0.004/0.006/0.017），因此住院时间延长（所有阶段 p<0.001），但对住院死亡率无显著影响（p=0.119/0.118/0.723）、90 天死亡率（p=0.259/0.118/0.723）、无病生存率（p=0.128/0.826/0.511）或总生存率（p=0.869/0.122/0.122）在任何疾病阶段均无显著影响。总生存率的预后因素包括肿瘤大小、肿瘤数量、甲胎蛋白水平和术后并发症 3A 级及以上。
围手术期输血与并发症发生率较高相关，但对肝细胞癌根治性肝切除术后的生存无显著影响。
