Effect of blood transfusion on survival for resected pancreatic neuroendocrine tumors: analysis of the U.S. neuroendocrine study group

Abstract

Background: Perioperative Packed Red Blood Cell (PRBC) transfusion (Tx) has been associated with worse survival in patients with pancreatic exocrine tumors. The effect of Tx in patients with pancreatic neuroendocrine tumors (PNETs), however, has not been examined. Methods: A retrospective cohort study of adult patients with resected PNETs was performed using the U.S. Neuroendocrine Study Group database (2000–2016). Demographic and clinical factors were compared by Tx status. Kaplan-Meier and log-rank analysis were used for survival analysis. Logistic regression was used to assess factors associated with Tx, overall (OS), recurrence free (RFS) and progression free survival (PFS). Results: Of the 1,169 PNET patients who underwent resection, 85% underwent curative operations and 15% underwent non-curative operations. 156 patients (14%) received perioperative Tx. Transfused patients had a higher ASA Class (p < 0.01), lower preoperative hemoglobin (Hgb; p < 0.01), larger tumors (4.6 v 3.0 cm, p < 0.01), more nodal involvement (41 v 25%, p < 0.01) and increased major complications (42 v 16%, p < 0.01). On multivariate analysis, ASA Class (p = 0.01), Hgb (p < 0.01), and estimated blood loss (p < 0.001) were associated with Tx. Tx was associated with worse 5-year OS (77 v 88%, p < 0.01) in all PNET patients. Tx was also associated with worse RFS (59 v 75%, p < 0.01) for patients with curative resections and worse PFS for patients with non- curative resections (45 v 73%, p = 0.05)(Table 1). On Cox multivariate analysis, Tx was independently associated with worse OS (HR 2.3, 95%CI 1.5–3.4, <0.001) and RFS (HR 1.5, 95%CI 1.1–2.2, p = 0.02) when controlling for TNM stage but not PFS (HR 1.9, 95%CI 0.97–3.8, p = 0.06). Conclusion: Perioperative Tx is associated with worse survival in patients with surgically resected PNETs. Strategies to minimize Tx in PNET patients should be developed and implemented.Table 15- and 10-year survival, transfused vs. non-transfused PNET patientsNumber patients included (n)Non-transfused patientsTransfused patientp-value5-year OSaOS: Overall Survival (includes all patients with PNET who underwent curative and palliative resection10-year OS1,16988%75%77%47%p<0.00015-year RFSbRFS: Recurrence Free Survival (includes only PNET patients who underwent curative resection – primary PNET +/− metastasectomy, with R0 or R1 margin status)10-year RFS99775%59%59%39%p-0.0095-year PFScPFS: Progression Free Survival (includes only patients with non-curative resections, margin status R2, regardless of presence of metastasis)10-year PFS17273%28%45%14%p=0.047a OS: Overall Survival (includes all patients with PNET who underwent curative and palliative resectionb RFS: Recurrence Free Survival (includes only PNET patients who underwent curative resection – primary PNET +/− metastasectomy, with R0 or R1 margin status)c PFS: Progression Free Survival (includes only patients with non-curative resections, margin status R2, regardless of presence of metastasis) Open table in a new tab