Busch O R, Hop W C, Marquet R L, Jeekel J
Department of Surgery, University Hospital Rotterdam-Dijkzigt, The Netherlands.
Ann Surg. 1994 Dec;220(6):791-7. doi: 10.1097/00000658-199412000-00013.
The authors analyzed the effect of blood transfusions on the pattern of colorectal cancer recurrence.
Retrospective studies suggest that blood transfusions are associated with a poor prognosis in patients who undergo operations for colorectal malignancies. In a previously published, randomized trial, it was investigated whether autologous blood transfusions could overcome this putative detrimental effect. However, this did not appear to be the case.
In the current study, the authors analyzed the patterns of recurrence in 420 patients who underwent curative operations for colorectal cancer.
Patients who did not require transfusions (N = 143) had significantly better disease-free survival than those who did need transfusions (N = 277); percentages at 4 years were 73% and 59%, respectively (p = 0.001). No difference was found between both groups in comparing cumulative percentages of patients having metastases; percentages at 4 years were 25% in the group that did not undergo transfusion and 27% in the transfused group. The percentage of cases having local recurrence, however, was significantly increased (p = 0.0006) in the transfused group as compared with the group that did not undergo transfusion; percentages at 4 years were 20% and 3%, respectively. The groups of patients receiving only allogeneic, only autologous, or both types of transfusions all had a significantly higher incidence of local recurrence than the patients who did not receive transfusions, but no differences were found between these three groups.
These findings suggest that the association between blood transfusions and prognosis in colorectal cancer is a result of the circumstances that necessitate transfusions, leading to the development of local recurrences, but not of distant metastases.
作者分析了输血对结直肠癌复发模式的影响。
回顾性研究表明，输血与接受结直肠癌手术患者的预后不良有关。在先前发表的一项随机试验中，研究了自体输血是否能克服这种假定的有害影响。然而，情况似乎并非如此。
在当前研究中，作者分析了420例行结直肠癌根治性手术患者的复发模式。
无需输血的患者（N = 143）的无病生存率明显高于需要输血的患者（N = 277）；4年时的百分比分别为73%和59%（p = 0.001）。两组在比较发生转移患者的累积百分比方面未发现差异；未输血组4年时的百分比为25%，输血组为27%。然而，与未输血组相比，输血组局部复发的百分比显著增加（p = 0.0006）；4年时的百分比分别为20%和3%。仅接受异体输血、仅接受自体输血或接受两种输血的患者组的局部复发发生率均显著高于未接受输血的患者，但这三组之间未发现差异。
这些发现表明，结直肠癌输血与预后之间的关联是需要输血的情况导致局部复发而非远处转移的结果。
