BACKGROUND Packed red blood cell (pRBC) transfusions in patients undergoing surgery for cancer are given to treat anemia or acute hemorrhage. Evidence indicates that pRBC transfusions are associated with poor perioperative and oncological outcomes. The ARCA-1 (Perioperative Care in the Cancer Patient-1) study was designed to test the association between perioperative pRBC transfusions and postoperative morbidity and mortality in patients undergoing cancer surgery. The primary hypothesis of our study was that perioperative pRBC transfusions have a negative impact on postoperative morbidity and 1-year mortality. METHODS ARCA-1 was an international multicenter prospective observational cohort study. Participating centers enrolled a minimum of 30 consecutive adult patients with cancer who underwent surgery with curative intent. The primary end point was all-cause mortality 1 year after major cancer surgery. Secondary end points were rates of perioperative blood product use, 1-year cancer-specific mortality, overall survival, and 30-day morbidity and mortality. We performed a propensity score matching analysis to adjust for selection bias. A multivariable logistic regression model was fitted to estimate the effects of significant covariates on 1-year mortality, cancer-related mortality, and overall survival. RESULTS A total of 1079 patients were included in the study. The rate of perioperative pRBC transfusions was 21.1%. Preoperative comorbidities, including anemia, American Society of Anesthesiologists (ASA) score of III to IV, a history of coronavirus disease 2019 (COVID-19), myocardial infarction, stroke, need for dialysis, history of blood transfusions, and metastatic disease were statistically significantly more frequent in transfused patients compared to nontransfused patients. The 1-year mortality rate was higher in transfused patients before (19.7% vs 6.5%; P < .0001) and after (17.4% vs 13.2%; P = .29) propensity score matching. 1-year mortality was 1.97 times higher in transfused than in no-transfused patients (odd ratio [OR], 1.97; 95% confidence interval [CI], 1.13-3.41). The odds of 1-year cancer mortality for patients who had perioperative pRBCs was 1.82 times higher (OR, 1.82; 95% CI, 0.97-3.43) compared to those who did not receive perioperative pRBC transfusion. The effect of perioperative pRBC transfusion on overall survival was also significant (hazard ratio [HR], 1.85; 95% CI, 1.15-2.99). Transfused patients also had a higher rate of 30-day postoperative mortality before (3.5% vs 0.7%; P = .0009) and after propensity score matching (4.2% vs 1.8%; P = .34). CONCLUSIONS This international, multicenter observational study showed that perioperative pRBC transfusion was associated with an increased mortality risk.

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围手术期红细胞输注与癌症大手术后 1 年死亡率之间的关联：一项国际多中心观察性研究。


背景 接受癌症手术的患者输注浓缩红细胞 （pRBC） 用于治疗贫血或急性出血。有证据表明，pRBC 输注与不良的围手术期和肿瘤学结局相关。ARCA-1 （癌症患者 1 的围手术期护理） 研究旨在测试围手术期 pRBC 输注与癌症手术患者术后发病率和死亡率之间的关联。我们研究的主要假设是围手术期 pRBC 输注对术后发病率和 1 年死亡率有负面影响。方法 ARCA-1 是一项国际多中心前瞻性观察队列研究。参与中心连续招募了至少 30 名接受治愈性手术的成年癌症患者。主要终点是癌症大手术后 1 年的全因死亡率。次要终点是围手术期血液制品使用率、 1 年癌症特异性死亡率、总生存期以及 30 天发病率和死亡率。我们进行了倾向得分匹配分析以调整选择偏倚。采用多变量 logistic 回归模型来估计显著协变量对 1 年死亡率、癌症相关死亡率和总生存期的影响。结果 共纳入 1079 例患者。围手术期 pRBC 输注率为 21.1%。 术前合并症，包括贫血、美国麻醉医师协会 （ASA） 评分 III 至 IV、2019 冠状病毒病 （COVID-19） 病史、心肌梗塞、中风、透析需求、输血史和转移性疾病在统计学上显着更常见与未输血的患者相比。之前输血患者的 1 年死亡率更高 （19.7% vs 6.5%;P < .0001） 和之后 （17.4% 对 13.2%;P = .29） 倾向得分匹配。输血患者的 1 年死亡率比未输血患者高 1.97 倍 （比值比 [OR]，1.97;95% 置信区间 [CI]，1.13-3.41）。与未接受围手术期 pRBC 输注的患者相比，围手术期 pRBC 患者的 1 年癌症死亡率比高 1.82 倍 （OR， 1.82;95% CI， 0.97-3.43）。围手术期 pRBC 输注对总生存期的影响也显著 （风险比 [HR]，1.85;95% CI，1.15-2.99）。输血患者术后 30 天死亡率也较高 （3.5% vs 0.7%;P = .0009） 和倾向评分匹配后 （4.2% 对 1.8%;P = .34）。结论 这项国际、多中心观察性研究表明，围手术期 pRBC 输注与死亡风险增加相关。