输注陈旧红细胞对肝细胞癌切除术后病人预后的影响  

Effect of Prolonged Storage of Packed Red Blood Cells on Recurrence-free and Overall Survivals after Curative Resection for Hepatocellular Carcinoma

作　　者：薛瑞峰 赵崇希 王培宗[1] 陈东泰[1] 陈晓辉[3] 曾维安[1] 李强[1] XUE Rui-feng;ZHAO Chong-xi;WANG Pei-zong;CHEN Dong-tai;CHEN Xiao-hui;ZENG Wei-an;LI Qiang(Department of Anesthesiology,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;Department of Anesthesiology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangzhou 510060,China;Department of Anesthesiology,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]中山大学肿瘤防治中心手术麻醉科,广东广州510060 [2]中山大学中山眼科中心麻醉科,广东广州510060 [3]福建省立医院麻醉科,福建福州350001

出　　处：《中山大学学报（医学科学版）》2022年第3期449-461,共13页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81971057);广东省自然科学基金(2021A1515011332)。

摘　　要：【目的】既往有研究表明,输注较长时间储存的红细胞可能使疾病的预后变差,尤其是创伤、重症和接受心脏手术的病人。为了探讨在肿瘤病人当中,输注红细胞的储存时间对肿瘤病人的远期预后是否有影响,本回顾性研究分析了术中输注红细胞对肝细胞癌切除术后病人的复发及总生存率的影响。【方法】本研究收集了2008年8月1日至2012年6月30日于中山大学肿瘤防治中心(中国,广州)接受肝细胞癌切除术的病人1221例,分为输血组与未输血组,其中输血组根据输注红细胞的储存时间进一步分为新鲜红细胞组(储存时间≤14 d)和陈旧红细胞组(储存时间>14 d)。对患者的总生存时间,肝内无复发生存时间,肝外无转移生存时间进行了分析,并采用多因素分析对不同储存时间的红细胞与肿瘤预后进行相关性分析。【结果】术中输注红细胞的病人共251例(20.6%),除14例患者新旧红细胞均有输注外,新鲜红细胞组112例,陈旧红细胞组125例。Kaplan–Meier生存分析显示输血组的总生存时间,肝内无复发生存时间,肝外无转移生存时间都更差(P<0.001),Cox多因素回归分析进一步提示输注陈旧红细胞是总生存时间(HR=1.417,P=0.049)和肝内无复发生存时间(HR=1.519,P=0.013)的独立影响因素,新鲜红细胞却不是。【结论】在接受肝细胞癌切除术的病人中,术中输注储存时间超过14 d的库存红细胞会增加术后肝内复发的风险且会缩短总生存时间,是一个影响预后的独立危险因素。【Objective】Prolonged storage of packed red blood cells(PRBC)is reportedly associated with poor clinical outcomes in critically ill,trauma,and cardiac surgery patients.However,the impact of PRBC’s age on long-term oncolog⁃ical outcomes in cancer patients remains poorly defined.Here we retrospectively evaluated the effect of PRBC’s age on overall survival and biochemical recurrence in patients undergoing curative resection of hepatocellular carcinoma.【Meth⁃ods】A total of 1221 qualified patients undergoing curative hepatectomy for HCC between August 1,2008 and June 30,2012 at the Sun Yat-sen University Cancer Center(Guangzhou,PR China)were divided into nontransfused or transfused group.Transfused patients were further divided according to PRBC storage duration(fresh PRBC group,≤14 days;old PRBC group,>14 days).Overall survival(OS),intrahepatic recurrence-free survival(IRFS),extrahepatic metastasis free survival(EMFS)were assessed and multivariate analyses were performed to evaluate the association of PRBC storage duration with cancer outcomes.【Results】A total of 251(20.6%)patients received intraoperative PRBC transfusion.Of these,112 and 125 patients were grouped in the fresh and the old PRBC groups,respectively.The Kaplan-Meier curves showed that both fresh PRBC group and old PRBC group had worse OS,IRFS,and EMFS than nontransfused group(P<0.001).Cox regression analyses further indicated that old PRBC transfusion was an independent prognostic factor of OS(HR=1.417,P=0.049),IRFS(HR=1.519,P=0.013)for patients with HCC;conversely,new PRBC transfusion was not.【Conclusion】In patients undergoing curative hepatectomy,intraoperative transfusions of PRBC that had been stored for more than 2 weeks is independently associated with a significantly increased risk of intrahepatic recurrence and reduced overall survival.

关 键 词：肝细胞肝癌 术中输血 新鲜红细胞 陈旧红细胞 远期预后 

分 类 号：R735.7[医药卫生—肿瘤]