Tang R, Wang J Y, Chien C R, Chen J S, Lin S E, Fan H A
Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
Cancer. 1993 Jul 15;72(2):341-8. doi: 10.1002/1097-0142(19930715)72:2<341::aid-cncr2820720206>3.0.co;2-e.
The authors undertook this study to test the hypothesis that perioperative blood transfusion has an adverse effect on survival of patients with colorectal cancer.
A retrospective analysis was performed on 725 patients who underwent curative resection for Dukes Stage B and C colorectal cancers in our institution between 1981-1985 and who were followed for 5-11 years.
Rectal cancers occurred more frequently in the transfused than in the nontransfused patients (64% versus 47%; P = 0.0001). In the patients with colon cancer, no significant effect of transfusion on recurrence-free survival was seen (P = 0.8, log-rank; P = 0.49, Cox regression analysis). The cumulative 5-year survival rate was 77% (95% confidence interval, 69-85%) for the nontransfused and 78% (72-83%) for the transfused patients. In patients with rectal cancer, the 5-year survival rate was 79% (67-87%) for the nontransfused and 67% (59-71%) for the transfused patients. A significant association was noted in patients with Stage B cancer (P = 0.002, log-rank; P = 0.02, Cox regression analysis), but not in those with Stage C cancer (P = 0.05, log-rank; P = 0.15, Cox regression analysis). In patients with Stage B rectal cancer, more frequent abdominoperineal resections (APR) were performed among the transfused patients (65% versus 32%; P = 0.0001). This subgroup was further stratified by operative procedure and reanalyzed using the same Cox regression model. Transfusion had no effect on survival of patients treated by APR (P = 0.31) or of those having a sphincter-saving procedure (P = 0.53).
The seemingly adverse effect of perioperative blood transfusion on the survival of patients with colorectal cancer may be explained by other covariates.
作者进行这项研究以检验围手术期输血对结直肠癌患者生存有不利影响这一假设。
对1981年至1985年间在本机构接受Dukes B期和C期结直肠癌根治性切除术且随访5至11年的725例患者进行回顾性分析。
输血患者中直肠癌的发生率高于未输血患者（64%对47%；P = 0.0001）。在结肠癌患者中，未观察到输血对无复发生存有显著影响（P = 0.8，对数秩检验；P = 0.49，Cox回归分析）。未输血患者的累积5年生存率为77%（95%置信区间，69 - 85%），输血患者为78%（72 - 83%）。在直肠癌患者中，未输血患者的5年生存率为79%（67 - 87%），输血患者为67%（59 - 71%）。在B期癌症患者中观察到显著关联（P = 0.002，对数秩检验；P = 0.02，Cox回归分析），但在C期癌症患者中未观察到（P = 0.05，对数秩检验；P = 0.15，Cox回归分析）。在B期直肠癌患者中，输血患者进行腹会阴联合切除术（APR）的频率更高（65%对32%；P = 0.0001）。该亚组按手术方式进一步分层，并使用相同的Cox回归模型重新分析。输血对接受APR治疗的患者生存（P = 0.31）或保留括约肌手术的患者生存（P = 0.53）均无影响。
围手术期输血对结直肠癌患者生存的看似不利影响可能由其他协变量解释。
