Abstract
ObjectivesThis study was designed to investigate the potential additive influence of perioperative blood transfusion (BTF) and postoperative infections on cancer-specific survival (CSS) in patients with stage II/III gastric cancer (GC) after radical gastrectomy.MethodsThe medical records of 2114 consecutive stage II/III GC patients who underwent curative resection and planned to receive adjuvant chemotherapy (AC) were retrospectively reviewed. The independent predictive factors for infections were identified using univariate and multivariate analyses. Cox regression analysis was used to assess any associations between BTF, infection and CSS.ResultsA total of 507 (24.0%) received perioperative BTF and 148 (7.0%) developed infections with BTF being identified as an independent predictor for infections. Both BTF and infections independently predicted poor CSS (hazard ratio [HR]: 1.193, 95% confidence interval [CI] 1.007–1.414; HR 1.323, 95% CI 1.013–1.727) and an additive effect was confirmed as patients who had both BTF and infection had even worse CSS. Further stratified analyses showed that complete AC (≥ 6 cycles) could significantly improve CSS in patients who had BTF and/or infection, which was comparable to those without BTF and/or infection (P = 0.496).ConclusionsInfection was the most common complication after gastrectomy and BTF was identified as an independent risk factor. BTF was associated with shorter CSS in stages II/III GC, independent of infections, and receiving BTF and developing infections had an additive effect that was associated with even worse CSS. However, complete AC could significantly improve CSS in these patients. Thus, strategies designed to ensure the completion of AC, such as neoadjuvant chemotherapy, should be further investigated.
Highlights
ObjectivesThis study was designed to investigate the potential additive influence of perioperative blood transfusion (BTF) and postoperative infections on cancerspecific survival (CSS) in patients with stage II/III gastric cancer (GC) after radical gastrectomy
We investigated the influence of a blood transfusion (BTF) on postoperative infections and the potential additive detrimental effect of a BTF and infections on cancer-specific survival (CSS) of patients with stage II/III gastric cancer (GC) after radical gastrectomy, by analyzing the data from a high-volume center in China
The present study from a high-volume center in China has revealed that BTF was a significant predictor for postoperative infectious complications following radical gastrectomy for stage II/III GC
Summary
This study was designed to investigate the potential additive influence of perioperative blood transfusion (BTF) and postoperative infections on cancerspecific survival (CSS) in patients with stage II/III gastric cancer (GC) after radical gastrectomy. Patients with GC in China and western countries are commonly diagnosed at locally advanced stage In these patients, besides a relatively high incidence of anemia when admitted to hospital, radical gastrectomy with D2 lymphadenectomy sometimes lead to massive hemorrhage even in high-volume centers.[3,4] As a result, approximately 20% of GC patients required blood transfusions (BTF) perioperatively.[5,6] While BTF is inevitable sometimes, transfusion-related immune modulation (TRIM) and systemic inflammation induced by a BTF leads to a higher incidence of postoperative complications, especially infections, and poorer prognosis.[5,6,7,8,9,10] In addition, a growing body of evidence supports that postoperative complications adversely affect the long-term survivals of GC patients.[11,12] Given that both a BTF and postoperative infectious complications can cause a strong inflammatory response, and results in a pro-tumor environment, we hypothesized that a synergistic unfavorable effect may be observed for survival of GC patients who had both a BTF and infection, a question to the best of our knowledge that has not been previously addressed
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