输血和输血量对肝细胞癌根治切除术后复发的影响

Impact of blood transfusion and transfusion volume on postsurgical recurrence of hepatocellular carcinoma

目的探讨输血和输血量是否可促进肝细胞癌(HCC)术后复发。方法回顾性分析中山大学附属第一医院2010年1月至2015年12月行根治性肝切除术的HCC患者1051例,根据术中输血的情况分为4组:无输血组(G1,691例)、输血量≤400 ml组(G2,92例)、输血量>400~1000 ml组(G3,114例)和输血量>1000 ml组(G4,154例)。比较各组术后无复发生存率(RFS)和总体生存率(OS),Cox风险回归模型分析研究HCC术后复发的危险因素。结果G1、G2、G3和G4组术后中位RFS分别为17.0、8.0、7.0、6.0个月,术后中位生存时间分别为96.0、31.0、28.0、25.0个月;G1组的术后生存显著优于其他三组(P<0.05);而G2、G3、G4组间术后中位RFS、OS比较,差异无统计学意义。Cox多因素回归分析显示,术中输血是影响HCC术后复发的危险因素(HR=1.392,P<0.001),而输血量对术后复发无显著影响。结论输血是HCC术后复发的危险因素,而输血量对HCC术后复发无影响。术前精准评估、术中精细操作和严格把握输血指征可改善HCC的预后。

Objective To evaluate whether blood transfusion and transfusion volume can promote recurrence of hepatocellular carcinoma(HCC)after surgery.Methods 1051 HCC patients undergoing curative liver resection from January 2010 to December 2015 in the First Affiliated Hospital of Sun Yat-sen University were retrospectively reviewed.The patients were allocated into group G1(no blood transfusion,691 cases),group G2(blood transfusion≤400 ml,92 cases),group G3(transfusion>400-1000 ml,114 cases)and group G4(transfusion>1000 ml,154 cases)according to the volume of blood transfusion.Postoperative relapse-free survival(RFS)and overall survival(OS)among the groups were compared.Furthermore,Cox multivariate analysis was applied to identify the risk factors associated with postoperative recurrence.Results The median RFS of group G1,G2,G3 and G4 was 17.0,8.0,7.0 and 6.0 months,respectively.The median OS was 96.0,31.0,28.0 and 25.0 months,respectively.The median RFS and OS of group G1 were markedly longer than those of group G2,G3 and G4(P<0.05).However,the median RFS and OS were comparable among group G2,G3 and G4.Cox multivariate analysis revealed that blood transfusion was a risk factor associated with postoperative recurrence of HCC(HR=1.392,P<0.001),but not the volume of blood transfusion.Conclusions Blood transfusion is the risk factor associated with HCC recurrence,but the volume of blood transfusion does not influence postsurgical recurrence of HCC.Precise preoperative evaluation,refined intraoperative manipulation and strict blood transfusion criteria may improve prognosis of HCC.