同种异体输血对食管癌患者手术预后的影响
The Effect of Allogenic Blood Transfusion on the Prognosis after Esophagectomy among Patients with Esophageal Cancer
-
摘要:
目的 探索同种异体输血 (allogenic blood transfusion, ABT) 对食管癌患者手术预后的影响.方法回顾性收集2009年1月至2017年6月于安康市中心医院住院并首次行食管切除术的500例食管癌患者, 根据病例是否接受ABT, 将其分为观察组 (n=417) 和对照组 (n=83) , 收集患者性别、年龄、肿瘤浸润深度 (T分期) 、淋巴结转移 (N分期) 、远处转移、肿瘤分级、手术方式、ABT、复发等指标, 并定期进行随访.结果 观察组和对照组在性别、年龄、肿瘤浸润深度、淋巴结转移、远处转移、和肿瘤分级方面无统计学差异 (P>0.05) ;而在手术方式和复发情况差异有统计学意义 (P<0.05) .多因素逻辑回归结果显示年龄、手术方式和ABT都是食管癌围手术期死亡的危险因素 (P<0.05) .其中, ABT与食管癌患者围手术期死亡率显著相关 (OR=3.0, 95%CI:1.45.6, P=0.03) .此外, ABT (-) 患者的总生存期比ABT (+) 患者更长 (P<0.05) .COX多因素回归分析结果显示, 肿瘤浸润程度、淋巴结转移、远处转移、手术方式和ABT都是影响食管癌患者总生存期的危险因素 (P<0.05) .其中, ABT与食管癌患者总生存期风险显著相关 (HR=2.4, 95%CI:1.63.7, P=0.001) .结论 ABT与食管癌患者围术期死亡率和总生存期之间存在相关性, 接受ABT的食管癌患者术后预后效果更差.
-
Key words:
- Allogenic blood transfusion (ABT) /
- Esophageal cancer /
- Prognosis /
- Overall survival
-
[1]鲍启德, 张长江, 刘敏, 等食管癌临床症状类型及其年龄和性别分布特征[J].新乡医学院学报, 2017, 34 (7) :570-573. [2]杨艳, 杜云翔, 张闯, 等.micro RNA-451在食管癌患者血清中的表达和疗效评估中的作用[J].新疆医科大学学报, 2017, 40 (6) :779-782. [3]赵骞, 宁旭.TP方案同步放化疗对非手术局部晚期食管癌的疗效[J].贵阳医学院学报, 2017, 42 (8) :952-956. [4]娄丽丽, 谢吻, 张盼, 等.中药注射剂联合化疗治疗食管癌有效性的网状Meta分析[J].兰州大学学报 (医学版) , 2016, 42 (1) :55-60. [5] [5]MAKOWIEC F, BAIER P, KULEMANN B, et al.Improved long-term survival after esophagectomy for esophageal cancer:influence of epidemiologic shift and neoadjuvant therapy[J].Journal of Gastrointestinal Surgery, 2013, 17 (7) :1193-1201. [6] [6]FACS E D M F, INDRANEEL DATTA M D, FRCSC F R S M, et al.Blood loss in surgical oncology:Neglected quality indicator[J].Journal of Surgical Oncology, 2009, 99 (8) :508. [7]梅礼军, 陈葳.输血患者不良反应的临床特点及其相关影响因素分析[J].国外医学医学地理分册, 2017, 38 (1) :45-47. [8] [8]KOMATSU Y, ORITA H, SAKURADA M, et al.Intraoperative blood transfusion contributes to decreased long-term survival of patients with esophageal cancer[J].World Journal of Surgery, 2012, 36 (9) :2263. [9] [9]GOODNOUGH L T, SHANDER A, SPIVAK J L, et al.Detection, evaluation, and management of anemia in the elective surgical patient[J].Anesthesia&Analgesia, 2005, 101 (6) :1858-1861. [10] [10]HBERT P C, WELLS G, BLAJCHMAN M A, et al.A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care.Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group[J].New England Journal of Medicine, 1999, 340 (6) :409-417. [11] [11]CERHAN J R, ENGELS E A, COZEN W, et al.Blood transfusion, anesthesia, surgery and risk of non-Hodgkin lymphoma in a population-based case-control study[J].International Journal of Cancer, 2008, 123 (4) :888. [12] [12]DOYLE B J, RIHAL C S, GASTINEAU D A, et al.Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention:Implications for contemporary practice[J].Journal of the American College of Cardiology, 2009, 53 (22) :2019-2027. [13] [13]BERNARD A C, DAVENPORT D L, CHANG P K, et al.Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients[J].Journal of the American College of Surgeons, 2009, 208 (5) :931-937. [14] [14]WEBER R S, JABBOUR N, II R C G M.Anemia and Transfusions in Patients Undergoing Surgery for Cancer[J].Annals of Surgical Oncology, 2008, 15 (1) :34. [15] [15]KNEUERTZ P J, PATEL S H, CHU C K, et al.Effects of perioperative red blood cell transfusion on disease recurrence and survival after pancreaticoduodenectomy for ductal adenocarcinoma[J].Annals of Surgical Oncology, 2011, 18 (5) :1327. [16] [16]WANG T, LUO L, HUANG H, et al.Perioperative blood transfusion is associated with worse clinical outcomes in resected lung cancer[J].Annals of Thoracic Surgery, 2014, 97 (5) :1827-1837. [17] [17]OPELZ G, TERASAKI P I.Improvement of kidney-graft survival with increased numbers of blood transfusions[J].New England Journal of Medicine, 1978, 299 (15) :799. [18] [18]BAUMGARTNER J M, SILLIMAN C C, MOORE E E, et al.Stored red blood cell transfusion induces regulatory T cells[J].Journal of the American College of Surgeons, 2009, 208 (1) :110-119. [19] [19]TAKEMURA M, OSUGI H, HIGASHINO M, et al.Effect of substituting allogenic blood transfusion with autologous blood transfusion on outcomes after radical oesophagectomy for cancer[J].Ann Thorac Cardiovasc Surg, 2005, 11 (5) :293-300. [20] [20]MELIS M, MCLOUGHLIN J M, DEAN E M, et al.Correlations between neoadjuvant treatment, anemia, and perioperative complications in patients undergoing esophagectomy for cancer[J].Journal of Surgical Research, 2009, 153 (1) :114-120. [21] [21]SATORU MOTOYAMA M D, MANABU OKUYAMA M D, MICHIHIKO KITAMURA M D, et al.Use of autologous instead of allogeneic blood transfusion during esophagectomy prolongs disease free survival among patients with recurrent esophageal cancer[J].Journal of Surgical Oncology, 2004, 87 (1) :26. [22] [22]LING F C, HOELSCHER A H, VALLB?HMER D, et al.Leukocyte depletion in allogeneic blood transfusion does not change the negative influence on survival following transthoracic resection for esophageal cancer[J].Journal of Gastrointestinal Surgery Official Journal of the Society for Surgery of the Alimentary Tract, 2009, 13 (4) :581. [23] [23]KADER A S, LIM J T, BERTHELET E, et al.Prognostic significance of blood transfusions in patients with esophageal cancer treated with combined chemoradiotherapy[J].American Journal of Clinical Oncology, 2007, 30 (5) :492. -
点击查看大图
计量
- 文章访问数: 2540
- HTML全文浏览量: 866
- PDF下载量: 26
- 被引次数: 0
下载:
