The influence of perioperative blood transfusion on intrahepatic recurrence after curative resection of hepatocellular carcinoma

OBJECTIVE: This study retrospectively evaluated the association between per ioperative blood transfusion and intrahepatic recurrence in patients with h epatocellular carcinoma (HCC) who had undergone curative hepatic resections . METHODS: Hepatic resection was performed with curative intent in 195 patien ts with primary HCC between 1985 and 1996; Patients who had received periop erative 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 nontransfus ed and transfused groups were 83.4% and 67.9%. 33.0% and 36.7%, and 23.1% a nd 24.6%, respectively (p = 0.175). Multivariate analysis of prognostic fac tors in all patients revealed that vascular invasion, tumor size (greater t han or equal to 5 cm), and Child's class were independent factors for intra hepatic recurrence. Further analyses in various stratified groups showed th at perioperative blood transfusion was an independent predictor of prognosi s 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 invasio n. As well, the more difficult surgery and the increased manipulation of th e liver that occur in these cases create a greater possibility of tumor dis semination. (C) 2000 by Am. Cell. of Gastroenterology.