围手术期成分输血对肝癌远期预后的影响

Effects of perioperative transfusion of blood components on the long-term prognosis of hepatocellularcarcinoma

目的探讨围手术期成分输血对肝癌远期预后的影响。 方法回顾性分析2003年1月至2010年12月在中国医学科学院肿瘤医院接受肝癌根治手术的339例患者的临床资料，并根据围手术期输血情况将患者分为未输血组、仅输血浆组和输红细胞组。应用Kaplan-Meier法计算无复发生存率和总生存率，Cox回归法对肝癌术后复发和生存相关的临床病理因素统计分析。 结果339例患者术后1、3、5年无复发生存率为63.1%、35.4%、22.4%，中位无复发生存期22个月；1、3、5年总生存率为90.5%、69.5%、56.4%，中位生存期72个月。未输血组（181例）、仅输血浆组（48例）和输红细胞组（110例）的中位无复发生存期和中位生存期分别为28、22、12个月和99、63、40个月，3组间无复发生存率和总生存率的差异均有统计学意义（均P〈0.01）。Cox多因素分析显示仅输血浆（HR＝1.658，P＝0.026）、输红细胞（HR＝1.470，P＝0.030）、血清甲胎蛋白〉400 μg/L（HR＝1.686，P＝0.002）、白蛋白〈35 g/L（HR＝1.782，P＝0.047）、肿瘤有包膜（HR＝0.597，P＝0.012）、肿瘤坏死（HR＝1.820，P＝0.001）和TNM分期Ⅲ期以上（HR＝2.537，P＝0.000）是肝癌术后生存的独立影响因素。 结论围手术期仅输血浆与围手术期输红细胞都对肝癌术后生存有不利影响。

Objective To investigate the effects of perioperative transfusion of blood components on the long-term prognosis of hepatocellular carcinoma （HCC） patients. Methods A total of 339 patients with primary HCC who underwent curative hepatectomy between January 2003 and December 2010 at the Cancer Hospital, Chinese Academy of Medical Sciences were enrolled. The clinical data of the patients were retrospectively analyzed. These patients were divided into non-transfusion, fresh frozen plasma （FFP） transfusion only and concentrated red cells （ CRC ） transfusion groups. Disease-free survival and overall survival were estimated using the Kaplan-Meier method, and Cox regression was performed to identify clinieopathological factors related with survival. Results Among the 339 patients, the 1-, 3- and 5-year disease-free survival rates were 63. 1% , 35.4% and 22. 4% , respectively, and the median disease-free survival was 22 months. While the 1-, 3- and 5-year overall survival rates were 90. 5%, 69. 5% and 56.4% , respectively, and the median overall survival was 72 months. The median disease-free survivals of the non-transfusion （ n = 181 ） , FFP transfusion only （ n = 48 ） and CRC transfusion （ n = 110 ） groups were 28, 22 and 12 months, respectively, while the median overall survivals of the three groups were 99, 63 and 40 months respectively. Significant differences in the disease-free and overall survivals were observed among the three groups （ both P 〈 O. 01 ）. Multivariate Cox regression analyses showed that FFP transfusion only （HR = 1. 658,P =0. 026）, CRC transfusion （HR = 1. 470,P =0. 030）, serum alpha-fetoprotein 〉400 μg/L （HR = 1. 686,P =0. 002）, albumin 〈35 g/L （HR = 1. 782,P =0. 047）, tumor capsule （HR =0. 597,P = O. 012） , tumor necrosis （ HR = 1. 820, P = 0. 001 ） and the TNM stage Ⅲ or above （ HR = 2. 537, P = 0. 000） were independent predictors of overall survival after hepatectomy. Conclusion Both perioperative FFP only transfusion and CRC transfusion may have detrimental effect on the long-term prognosis of HCC.