Effect of red blood cell transfusion on prognosis of patients with advanced-stage cancer and its influencing factors
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摘要: 目的 分析红细胞输血在肿瘤晚期患者中的影响因素及其对预后的作用。方法 纳入2012至2015年在医院接受姑息治疗的晚期肿瘤患者349例, 分析与红细胞输血相关的患者特征因素, 以及输血与患者生存率的关系。结果 纳入的患者中89例(25.5%)在治疗期间至少进行过1次红细胞输血, 体力状况(PS)评分≥2分(OR=1.37, 95%CI: 1.13~2.54,P=0.012)、现居住于城市(OR=2.53, 95%CI: 1.43~4.83,P=0.007)、血液肿瘤类型(OR=1.29, 95%CI: 1.09~2.47,P=0.038)和放化疗(OR=1.86, 95%CI: 1.18~3.04,P=0.022)是红细胞输血的独立相关因素。所有患者的中位生存期为15.5个月, 行红细胞输血治疗患者的中位生存期为21.4个月, 未输血组的中位生存期为13.2个月, 差异有统计学意义(P< 0.001)。年龄＞65岁(HR=1.67, 95%CI: 1.08~2.11,P=0.023)、PS评分≥2分(HR=2.13, 95%CI: 1.35~3.04,P=0.021)、在疗养院或医院护理(保护因素,HR=0.53, 95%CI: 0.43~0.83,P=0.007)、靶向或免疫治疗(保护因素,HR=0.51, 95%CI: 0.36~0.87,P=0.042)和未行红细胞输血(HR=1.44, 95%CI: 1.09~3.76,P=0.010)是总体生存率的独立危险因素。结论 晚期肿瘤患者的输血需求不仅取决于医疗因素, 还与社会和家庭因素相关, 红细胞输血治疗与晚期患者生存率的提高相关。Abstract: Objective To analyze the factors associated with red blood cell transfusion in patients with advanced-stage cancer and its role on prognosis.Methods A total of 349 patients with advanced-stage cancer who received palliative care in hospitals from 2012 to 2015 were enrolled in this retrospective study. Patients' characteristics associated with red blood cell transfusion and the relationship between transfusion and patients' survival were analyzed.Results Of the enrolled patients, 89 cases(25.5%) had at least one red blood cell transfusion during treatment. PS score≥2(OR=1.37, 95%CI: 1.13-2.54,P=0.012), living in urban area(OR=2.53, 95%CI: 1.43-4.83,P=0.007), hematologic tumor type(OR=1.29, 95%CI: 1.09-2.47,P=0.038), and chemoradiotherapy(OR=1.86, 95%CI: 1.18-3.04,P=0.022) were independent correlators of red blood cell transfusion. The median survival was 15.5 months for all patients, 21.4 months for those treated with red blood cell transfusion and 13.2 months for the non-transfused group, with a statistically significant difference(P< 0.001). Age>65 years(HR=1.67, 95%CI: 1.08-2.11,P=0.023), PS score ≥2(HR=2.13, 95%CI: 1.35-3.04,P=0.021), nursing at nursing home or hospital(protective factor,HR=0.53, 95%CI: 0.43-0.83,P=0.007), targeted or immunotherapy(protective factor,HR=0.51, 95%CI: 0.36-0.87,P=0.042), and without red blood cell transfusion(HR=1.44, 95%CI: 1.09-3.76,P=0.010) were independent risk factors for overall survival.Conclusion The need for blood transfusion in the patients with advanced cancer may not only depend on medical factors, but also on social and family factors. Red blood cell transfusion therapy may be associated with improved survival in the patients with advanced cancer.
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Key words:
- red blood cell /
- transfusion /
- advanced-stage cancer /
- prognosis
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表 1 入组患者的基线特征比较
例(%) 项目 输血组
(89例)未输血组
(260例)P 年龄/岁 67.5(48.5~80.5) 70.0(46.5~82.0) 0.224 性别 0.460 男 57(64.0) 155(59.6) 女 32(36.0) 105(40.4) 吸烟史 0.072 是 58(65.2) 141(54.2) 否 31(34.8) 119(45.8) 饮酒史 0.495 是 41(46.1) 109(41.9) 否 48(53.9) 151(58.1) 子女数量 0.049 0~1 28(31.5) 55(21.2) >1 61(68.5) 205(78.8) 现居住地 0.001 城市 72(80.9) 161(61.9) 农村 17(19.1) 99(38.1) 日常护理地点 0.040 家或养老院 63(70.8) 211(81.2) 疗养院或医院 26(29.2) 49(18.8) 合并症 0.699 0~1 12(13.5) 31(11.9) >1 77(86.5) 229(88.1) 肿瘤类型 0.013 血液系统肿瘤 22(24.7) 35(13.5) 实体肿瘤 67(75.3) 225(86.5) 抗肿瘤治疗方式 < 0.001 仅姑息治疗 10(11.2) 35(13.5) 放化疗 62(69.7) 118(45.4) 靶向或免疫治疗 17(19.1) 107(41.1) PS评分 0.008 0~1 43(48.3) 167(64.2) 2~4 46(51.7) 93(35.8) 入院血红蛋白/(g·L-1) 77.5(72.1~91.3) 96.5(82.8~114.2) < 0.001 既往输血史 < 0.001 是 48(53.9) 77(29.6) 否 41(46.1) 183(70.4) 
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表 2 输血与否的多因素logistic回归分析
项目 OR 95%CI P PS(≥2 vs 0~1) 1.37 1.13~2.54 0.012 子女数量(0~1 vs >1) 1.65 0.53~3.82 0.121 现居住地(城市vs农村) 2.53 1.43~4.83 0.007 护理地点(疗养院或医院vs家或养老院) 1.25 0.75~2.22 0.085 肿瘤类型(血液肿瘤vs实体肿瘤) 1.29 1.08~2.47 0.038 治疗方式(放化疗vs其他治疗) 1.86 1.18~3.04 0.022 血红蛋白(< 100 g/L vs ≥100 g/L) 1.33 0.84~2.87 0.117 既往输血史(有vs无) 2.01 0.85~3.74 0.312
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表 3 入组患者总体生存的Cox危险因素分析
项目 单因素分析 多因素分析 HR 95%CI P HR 95%CI P 年龄(>65岁vs ≤65岁) 1.72 1.14~2.25 0.011 1.67 1.08~2.11 0.023 性别(男vs女) 1.45 0.93~1.95 0.065 2.71 0.61~4.02 0.781 PS(≥2 vs 0~1) 2.21 1.61~2.91 < 0.001 2.13 1.35~3.04 0.021 子女数量(0~1 vs >1) 1.19 0.82~1.45 0.179 现居住地(农村vs城市) 1.33 0.72~1.87 0.318 护理地点(疗养院或医院vs家或养老院) 0.46 0.41~0.68 < 0.001 0.53 0.43~0.83 0.007 肿瘤类型(血液肿瘤vs实体肿瘤) 1.42 0.77~1.98 0.821 血红蛋白(<100 g/L vs ≥100 g/L) 1.19 0.88~1.86 0.270 既往输血史(有vs无) 1.21 0.89~1.82 0.198 饮酒史(有vs无) 1.87 0.75~2.51 0.162 吸烟史(有vs无) 1.81 0.71~2.32 0.218 合并症(>1 vs 0~1) 1.65 1.13~3.88 0.021 1.47 0.85~2.85 0.141 治疗方式 放化疗vs仅姑息治疗 0.69 0.45~0.98 0.009 0.65 0.401.89 0.105 靶向或免疫vs仅姑息治疗 0.49 0.36~0.66 < 0.001 0.51 0.36~0.87 0.042 红细胞输血(无vs有) 1.59 1.18~3.98 0.002 1.44 1.09~3.76 0.010
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