Effect of acute normovolemic hemodilution on long-term prognosis of patients with oral squamous cell carcinoma undergoing flap reconstruction: a retrospective study

Abstract

Objective To investigate the effect of acute normovolemic hemodilution on long-term prognosis of oral squamous cell carcinoma (OSCC) patients after tumor resection and flap reconstruction. Methods This study retrospectively analyzed follow-up data for 371 OSCC patients who underwent tumor resection and flap reconstruction for the first time at our hospital from January 1, 2015, to December 31, 2020. The patients were split into three groups: no blood transfusion (NBT), acute normovolemic hemodilution (ANH), and allogeneic blood transfusion (ABT). Measurement data were analyzed by ANOVA and enumeration data by χ2 tests. Survival analysis with the Cox model was used to confirm independent prognostic factors. Disease-free (DFS) and overall (OS) survival were calculated by the life table method and K-M curve. Results The ANH group had a 0.523-fold higher risk of recurrence than the NBT group (P = 0.010). The ABT group had a 1.844-fold higher risk of death than the NBT group (P = 0.033). Among those with lymph node metastasis, the ANH group had a lower risk of recurrence, 0.436 times higher than the NBT group (P = 0.017), and the ABT group had a higher risk of death, 2.186 times higher than the NBT group (P = 0.032). Conclusion ANH can reduce immune system suppression by decreasing the amount of allogeneic blood to reduce tumor recurrence and risk of tumor-specific death, and this result is more prominent in OSCC patients with lymph node metastasis. Clinical relevance Preoperative ANH can effectively reduce the recurrence rate of patients with OSCC.