Swisher S G, Holmes E C, Hunt K K, Gornbein J A, Zinner M J, McFadden D W
Department of Surgery, University of California, Los Angeles Medical Center, USA.
J Thorac Cardiovasc Surg. 1996 Aug;112(2):341-8. doi: 10.1016/S0022-5223(96)70260-X.
We evaluated retrospectively the effect of perioperative blood transfusions on survival in esophageal cancer. The records of all patients who underwent esophageal resection (n = 316) at UCLA Medical Center from 1970 to 1993 were reviewed. Statistical analysis included univariate (log-rank chi 2) and multivariate (Cox proportional hazards) analyses with other known risk factors. High-volume blood transfusions (> 8 units) but not low-volume blood transfusions (1 to 8 units) were associated with a significant decrease in long-term survival (median survival: no transfusion, 22 months; low-volume blood transfusion, 14.5 months, versus high-volume blood transfusions, 6.5 months; p < 0.01). Multivariate analysis revealed that the shorter survival with high-volume blood transfusions was a result of an increased number of postoperative complications. High-volume blood transfusions were not associated with increases in tumor recurrence or infectious complications. The association between shorter survival and high-volume blood transfusions in esophageal cancer may, therefore, be because of the circumstances necessitating transfusion rather than any immunosuppressive effects of the transfused blood. These findings suggest that the transfusion of blood does not by itself decrease the chance of cure after esophageal resection.
我们回顾性评估了围手术期输血对食管癌患者生存的影响。对1970年至1993年间在加州大学洛杉矶分校医学中心接受食管切除术的所有患者（n = 316）的记录进行了审查。统计分析包括单因素（对数秩卡方检验）和多因素（Cox比例风险模型）分析，并纳入其他已知风险因素。大量输血（> 8单位）而非少量输血（1至8单位）与长期生存率显著降低相关（中位生存期：未输血者为22个月；少量输血者为14.5个月，大量输血者为6.5个月；p < 0.01）。多因素分析显示，大量输血导致生存期缩短是术后并发症数量增加所致。大量输血与肿瘤复发或感染性并发症增加无关。因此，食管癌患者生存期缩短与大量输血之间的关联可能是由于需要输血的情况，而非输血本身的任何免疫抑制作用。这些发现表明，输血本身并不会降低食管切除术后的治愈机会。
