Houbiers J G, Brand A, van de Watering L M, Hermans J, Verwey P J, Bijnen A B, Pahlplatz P, Eeftinck Schattenkerk M, Wobbes T, de Vries J E
Department of Immunohaematology and Blood Bank, University Hospital, Leiden, Netherlands.
Lancet. 1994 Aug 27;344(8922):573-8. doi: 10.1016/s0140-6736(94)91965-8.
In retrospective studies, perioperative blood transfusions were associated with poor prognosis after surgery for cancer and were a major independent risk factor for postoperative bacterial infection. Leucocyte-depleted, in contrast to buffy-coat-depleted, blood has no immunosuppressive effects in transplantation and so might lack detrimental effects on cancer prognosis and postoperative infections. We studied this hypothesis in a controlled trial by randomly allocating patients to receive either leucocyte-depleted red cells or packed cells without buffy coat when blood was needed. Between 1987 and 1990, 871 eligible patients with colorectal cancer, including 697 patients operated upon with curative intent, were randomised in the 16 participating hospitals. Neither the eligible group nor the curative group showed significant differences between the two trial transfusions in survival, disease-free survival, cancer recurrence rates, or overall infection rates after an average follow-up of 36 months. Patients who had a curative resection and who received blood of any sort had a lower 3-year survival than non-transfused patients (69% vs 81%, p = 0.001) and a higher infection rate (39% vs 24%, p < 0.001). Colorectal cancer recurrence rates, however, were not influenced by blood transfusion (30% vs 26%, p = 0.22). These combined observations confirm the association between blood transfusion and poor patient survival but indicate that the relation is not due to promotion of cancer.
在回顾性研究中，围手术期输血与癌症手术后的不良预后相关，并且是术后细菌感染的主要独立危险因素。与去除白膜层的血液相比，去除白细胞的血液在移植中没有免疫抑制作用，因此可能对癌症预后和术后感染没有有害影响。我们在一项对照试验中研究了这一假设，当需要输血时，将患者随机分配接受去除白细胞的红细胞或去除白膜层的浓缩红细胞。在1987年至1990年间，16家参与研究的医院将871例符合条件的结直肠癌患者，包括697例接受根治性手术的患者进行了随机分组。在平均随访36个月后，符合条件的组和根治性组在两种试验性输血之间，在生存率、无病生存率、癌症复发率或总体感染率方面均未显示出显著差异。接受根治性切除并接受任何一种输血的患者的3年生存率低于未输血的患者（69%对81%，p = 0.001），感染率更高（39%对24%，p < 0.001）。然而，结直肠癌复发率不受输血影响（30%对26%，p = 0.22）。这些综合观察结果证实了输血与患者不良生存之间的关联，但表明这种关系并非由于促进癌症所致。
