title: The influence of perioperative blood transfusion on intrahepatic recurrence after curative resection of hepatocellular carcinoma.
abstract: OBJECTIVE
  This study retrospectively evaluated the association between perioperative blood transfusion and intrahepatic recurrence in patients with hepatocellular carcinoma (HCC) who had undergone curative hepatic resections.
  
  
  METHODS
  Hepatic resection was performed with curative intent in 195 patients with primary HCC between 1985 and 1996. Patients who had received perioperative blood transfusion (transfused group: n = 117) and those who had no perioperative blood transfusion (nontransfused group: n = 78) were compared in terms of conventional prognostic variables and cancer-free survival by the univariate and multivariate analyses.
  
  
  RESULTS
  The 1-, 3-, and 5-yr cancer-free survival rates in the nontransfused and transfused groups were 83.4% and 67.9%, 43.0% and 36.7%, and 23.1% and 24.6%, respectively (p = 0.175). Multivariate analysis of prognostic factors in all patients revealed that vascular invasion, tumor size (> or =5 cm), and Child's class were independent factors for intrahepatic recurrence. Further analyses in various stratified groups showed that perioperative blood transfusion was an independent predictor of prognosis in HCC patients with portal vein invasion (RR: 2.8, p = 0.0038). The 1-, 3-, and 5-yr survival rates in the nontransfused and transfused groups with portal vein invasion were 71.9% and 41.6%, 54.5% and 10.9%, and 26% and 0%, respectively (p = 0.0003).
  
  
  CONCLUSIONS
  We conclude that perioperative blood transfusions enhance the risk of intrahepatic recurrence of HCC in patients with portal vein invasion. As well, the more difficult surgery and the increased manipulation of the liver that occur in these cases create a greater possibility of tumor dissemination.
authors.affiliation: Second Department of Surgery, Shimane Medical University, Izumo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Makino
authors.forename: A
authors.initials: A
authors.lastname: Yamanoi
authors.forename: T
authors.initials: T
authors.lastname: Kimoto
authors.forename: O N
authors.initials: ON
authors.lastname: El-Assal
authors.forename: H
authors.initials: H
authors.lastname: Kohno
authors.forename: N
authors.initials: N
authors.lastname: Nagasue
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006503:Hepatic Veins / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D011169:Portal Vein / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D065227:Transfusion Reaction