对接受游离组织转移的头颈癌患者实施更严格输血标准的影响

IF 1.6 4区医学 Q2 OTORHINOLARYNGOLOGY Laryngoscope Investigative Otolaryngology Pub Date : 2024-10-18 DOI:10.1002/lio2.70021

Osama A. Hamdi MD, Deepa Danan MD, Amber Denner MD, Jeffrey R. Bellinger MD, Noah Thornton BS, David C. Shonka MD, Jonathan C. Garneau MD, Katherine Fedder MD, Mark J. Jameson MD, PhD, Eric M. Dowling MD

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引用次数: 0

摘要

目的近期研究输血对头颈癌（HNC）患者预后影响的文献表明，输血与死亡风险增加和伤口感染率升高有关。本研究的目的是降低输血阈值，同时比较新输血指南实施后游离皮瓣患者的预后。方法对 2007 年 7 月 17 日至 2021 年 6 月 7 日期间在一家三级医疗学术中心接受 HNC 切除术后游离组织转移的所有患者进行回顾性研究。输血标准于 2014 年进行了调整；输血的血细胞比容阈值从 2007 年的 30% 逐步降至 2017 年的 21%。主要研究结果为总生存期（OS）和无复发生存期（RFS）。结果共有346名患者符合纳入研究的标准。第1组（不太严格的方案--30%）和第2组（更严格的方案--21%）分别有171名和175名患者。第 2 组每名患者输注的包装红细胞单位较少（第 1 组为 0.26 个单位，第 2 组为 2.87 个单位，P < .001）。第1组患者的OS（p = .01；危险比 [HR] = 1.7）和RFS（p < .001；HR = 2.5）较差。仅比较两组 SCC 患者的情况也显示，第 1 组的 OS（p = .01；HR = 1.8）和 RFS（p = .006；HR = 2.1）更差。结论在接受游离组织转移的 HNC 患者中，更严格的输血标准（血细胞比容阈值为 21%）与 OS、RFS 和并发症发生率的改善相关，对游离皮瓣存活率没有负面影响。证据等级 IV 级。

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Impact of implementing stricter criteria for blood transfusion in patients with head and neck cancer undergoing free tissue transfer

Objective

Recent literature studying the impact of blood transfusion on outcomes in patients with head and neck cancer (HNC) have shown that blood transfusions are associated with increased risk of death and higher wound infection rates. The purpose of this study was to implement a lower transfusion threshold while comparing outcomes of free flap patients following initiation of a new transfusion guideline.

Methods

A retrospective study of all patients at a tertiary care academic center who underwent free tissue transfer after HNC resection between July 17, 2007 and June 7, 2021. Transfusion criteria were adjusted in 2014; the hematocrit threshold to transfuse was incrementally reduced from 30% in 2007 to 21% in 2017. The main outcomes of interest were overall survival (OS) and recurrence free survival (RFS).

Results

A total of 346 patients met the criteria for inclusion in the study. Groups 1 (less strict protocol – 30%) and 2 (stricter protocol – 21%) consisted of 171 and 175 patients, respectively. Fewer units of packed red cells were transfused per patient in group 2 (0.26 vs. 2.87 in group 1, p < .001). Group 1 was associated with worse OS (p = .01; hazard ratio [HR] = 1.7) and RFS (p < .001; HR = 2.5). Comparing only patients with SCC between the two groups also demonstrated poorer OS (p = .01; HR = 1.8) and RFS (p = .006; HR = 2.1) in group 1.

Conclusion

In HNC patients undergoing free tissue transfer, stricter transfusion criteria with threshold hematocrit of 21% was associated with improved OS, RFS, and complication rates with no negative impact on free flap survival.