title: Perioperative blood transfusion and survival following curative hepatic resection for hepatocellular carcinoma.
abstract: OBJECTIVE
  The association between transfusion and recurrence after resection for hepatocellular carcinoma (HCC) is still under debate. The influences of perioperative blood transfusion on survival and recurrence after curative hepatic resection for HCC and prognostic factors in patients with blood transfusion were evaluated.
  
  
  METHODS
  Curative hepatectomy was performed in 210 patients (57%) with and 158 (43%) without perioperative blood transfusion. Prognostic factors were evaluated by univariate and multivariate analysis using Cox's proportional hazards model.
  
  
  RESULTS
  Multivariate analysis revealed that perioperative blood transfusion was an independent predictor for recurrence in patients with serum low albumin level (< 3.5 g/dL). In transfused group, stage IV, large tumor size (> or = 5 cm), high value of ICGR15 (> or = 20%), and old age (> or = 60 year) were independent factors of poor disease-free survival.
  
  
  CONCLUSIONS
  Perioperative blood transfusion promotes the recurrence of HCC after hepatic resection in patients with hypo-albuminemia. In transfused patients, establishment of strategy for recurrence based on pTNM staging, tumor size, ICGR15, and age may be required to improve survival.
authors.affiliation: Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan. hanayan@hsp.md.shinshu-u.ac.jp
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hanazaki
authors.forename: Shoji
authors.initials: S
authors.lastname: Kajikawa
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Shimozawa
authors.forename: Akimasa
authors.initials: A
authors.lastname: Matsushita
authors.forename: Taiichi
authors.initials: T
authors.lastname: Machida
authors.forename: Ko
authors.initials: K
authors.lastname: Shimada
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Yazawa
authors.forename: Naohiko
authors.initials: N
authors.lastname: Koide
authors.forename: Wataru
authors.initials: W
authors.lastname: Adachi
authors.forename: Jun
authors.initials: J
authors.lastname: Amano
mesh_terms: D000368:Aged; D000375:Aging; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D004396:Coloring Agents / Q000493:pharmacokinetics; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics; D007430:Intraoperative Care; D008113:Liver Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011182:Postoperative Care; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000172:deficiency; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D004396:Coloring Agents; D012709:Serum Albumin; D007208:Indocyanine Green