围手术期输血对胃癌患者预后的影响

Effect of perioperative blood transfusion on the prognosis of gastric cancer

目的探讨围手术期输血对胃癌患者预后的影响。方法回顾性分析1000例胃癌手术患者，其中未输血者738例（73．8％），输血者262例（26．2％）。除患者入院时血红蛋白水平及术中失血量外，其他临床病理资料均用倾向评分法进行配对，分析胃癌输血患者和未输血患者的生存情况。结果1000例胃癌手术患者的5年生存率为39．9％。配对前，738例未输血患者的5年生存率为49．1％，262例输血患者的5年生存率为33．6％，差异有统计学意义（P〈0．05）。单因素分析显示，患者年龄、肿瘤大小、血红蛋白水平、白蛋白水平、肿瘤浸润深度、淋巴结转移、淋巴结清扫范围、手术方式、辅助化疗、术中失血量及围手术期输血情况与胃癌手术患者的预后有关（均P〈0．05）。多因素分析显示，肿瘤浸润深度、淋巴结转移、淋巴结清扫范围、辅助化疗及围手术期输血情况为影响胃癌手术患者预后的独立因素（均P〈0．05）。经配对后，262例未输血患者的5年生存率为37．7％，262例输血患者的5年生存率为33．6％，差异无统计学意义（P=0．217）。结论围手术期输血对胃癌患者的长期预后没有影响。

Objective To explore the association of perioperative blood transfusion （PBT） with survival of gastric cancer after surgery. Methods We retrospectively reviewed the medical records of 1 000 gastric cancer patients, including 738 non-transfused （ 73.8% ） and 262 transfused （ 26.2% ） cases. A one to one match was created using propensity score analysis, except preoperative hemoglobin level and operative blood loss. The survival was analyzed by Kaplan-Meier survival model. Results The 5-year survival rate of the 1 000 cases of gastric cancer patients was 39.9%. Before matching, there was a significant difference between transfused group （ 33.6% ） and non-transfused group （ 49.1%, P 〈 0.005 ）. Univariate analysis showed that age, tumor size, hemoglobin level, albumin level, depth of invasion, lymph node metastasis, lymph node dissection, surgery mode, adjuvant chemotherapy, blood loss and blood transfusion during perioperative period were associated with prognosis in the gastric cancer patients （all P〈0.05）. Multivariate analysis showed that tumor invasion, lymph node metastasis, lymph node dissection, chemotherapy and perioperative blood transfusion were independent prognostic factors in gastric cancer （all P〈0.05 ）. After matching, the 5-year survival rate of the 262 non-transfused patients was 37.7%, while that of the 262 transfused patients was 33.6% （P〉0.05）. Conclusions Perioperative blood transfusion has no significant effect on the prognosis of gastric cancer patients.