Joint effect of pre-operative anemia and perioperative blood transfusion on outcomes of colon-cancer patients undergoing colectomy  

术前贫血和围手术期输血对结肠癌手术患者预后的联合影响

作　　者：Zheng Liu Jia-Jun Luo Kevin Y.Pei Sajid A.Khan Xiao-Xu Wang Zhi-Xun Zhao Ming Yang Caroline H.Johnson Xi-Shan Wang Yawei Zhang 

机构地区：[1]Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,China [2]Department of Surgery,Yale School of Medicine,New Haven,CT,USA [3]Department of Surgery,School of Medicine,Texas Tech University Health Sciences Center,Lubbock,TX,USA [4]Department of Environmental Health Sciences,Yale School of Public Health,New Haven,CT,USA

出　　处：《Gastroenterology Report》2020年第2期151-157,I0003,共8页胃肠病学报道（英文）

基　　金：supported by the Beijing Municipal Science&Technology Commission[No.Z161100000116090];the National Key Research and Development Program of the Ministry of Science and Technology of China[No.2016YFC0905303];the CAMS Innovation Fund for Medical Sciences(CIFMS)[No.2016-I2M-1–001];the Beijing Science and Technology Program[No.D17110002617004].

摘　　要：Background:Both pre-operative anemia and perioperative(intra-and/or post-operative)blood transfusion have been reported to increase post-operative complications in patients with colon cancer undergoing colectomy.However,their joint effect has not been investigated.The purpose of this study was to evaluate the joint effect of pre-operative anemia and perioperative blood transfusion on the post-operative outcome of colon-cancer patients after colectomy.Methods:We identified patients from the American College of Surgeons National Surgical Quality Improvement Program(NSQIP)database 2006–2016 who underwent colectomy for colon cancer.Multivariate logistic regression analysis was employed to assess the independent and joint effects of anemia and blood transfusion on patient outcomes.Results:A total of 35,863 patients—18,936(52.8%)with left-side colon cancer(LCC)and 16,927(47.2%)with right-side colon cancer(RCC)—were identified.RCC patients were more likely to have mild anemia(62.7%)and severe anemia(2.9%)than LCC patients(40.2%mild anemia and 1.4%severe anemia).A total of 2,661(7.4%)of all patients(1,079[5.7%]with LCC and 1,582[9.3%]with RCC)received a perioperative blood transfusion.Overall,the occurrence rates of complications were comparable between LCC and RCC patients(odds ratio[OR]=1.01;95%confidence interval[CI]=0.95–1.07;P=0.750).There were significant joint effects of anemia and transfusion on complications and the 30-day death rate(P for interaction:0.010).Patients without anemia who received a transfusion had a higher risk of any complications(LCC,OR=3.51;95%CI=2.55–4.85;P<0.001;RCC,OR=3.74;95%CI=2.50–5.59;P<0.001),minor complications(LCC,OR=2.54;95%CI=1.63–3.97;P<0.001;RCC,OR=2.27;95%CI=1.24–4.15;P=0.008),and major complications(LCC,OR=5.31;95%CI=3.68–7.64;P<0.001;RCC,OR=5.64;95%CI=3.61–8.79;P<0.001),and had an increased 30-day death rate(LCC,OR=6.97;95%CI=3.07–15.80;P<0.001;RCC,OR=4.91;95%CI=1.88–12.85;P=0.001)than patients without anemia who did not receive a transfusion.Conclusions背景:术前贫血和围手术期(术中和/或术后)输血被报道会增加结肠癌手术患者术后并发症发生率。然而,其联合影响尚无研究。本研究旨在评估术前贫血和围手术期输血对结肠癌手术患者的联合影响。方法:我们从美国外科医师协会的国家手术质量改进项目(NSQIP)数据库中筛选出2006-2016年间接受结肠切除术的结肠癌病例。采用多因素逻辑回归分析评估术前贫血和围手术期输血对预后的独立及联合影响。结果:35,936例结肠癌患者纳入分析,其中左半结肠癌(LCC)18,936例(52.8%),右半结肠癌(RCC)16,927例(47.2%)。RCC患者中术前轻度贫血(62.7%vs 40.2%)和重度贫血(2.9%vs 1.4%)的比例均高于LCC患者。共计2661例(7.4%)患者接受了围手术期输血,其中LCC 1079例(5.7%),RCC 1582例(9.3%)。术后总体并发症发生率LCC与RCC患者的差异无统计学意义(OR=1.01,95%CI:0.95–1.07,P=0.750)。术前贫血和围手术期输血对术后并发症发生率及30天病死率存在一个显著的联合影响(交互P值为0.010)。与无贫血且未输血者相比,无贫血但接受输血的患者术后并发症发生风险增高,无论是总体并发症(LCC:OR=3.51,95%CI:2.55–4.85,P<0.001;RCC:OR=3.74,95%CI:2.50–5.59,P<0.001),轻微并发症(LCC:OR=2.54,95%CI:1.63–3.97,P<0.001;RCC:OR=2.27,95%CI:1.24–4.15,P=0.008),还是严重并发症(LCC:OR=5.31,95%CI:3.68–7.64,P<0.001;RCC:OR=5.64,95%CI:3.61–8.79,P<0.001);同时,术后30天病死率也显著增高(LCC:OR=6.97,95%CI:3.07–15.80,P<0.001;RCC:OR=4.91,95%CI:1.88–12.85,P=0.001)。结论:术前贫血和围手术期输血会增加结肠癌手术患者术后并发症及围手术期死亡风险。

关 键 词：colon cancer COLECTOMY ANEMIA blood transfusion 

分 类 号：R735.35[医药卫生—肿瘤]