Abstract
ObjectivesTo evaluate the impact of preoperative anemia and perioperative blood transfusion (PBT) on disease free (DFS) and overall survival (OS) of patients with head and neck squamous cell carcinoma (HNSCC).MethodsRetrospective study of 354 patients primarily treated with surgery between 2006 and 2016. Cases were selected according to completeness and accuracy of available clinical data. Thus, a selection bias cannot be excluded. Patients who received PBT were identified by our controlling department and verified by our blood bank data base.ResultsBoth, preoperative anemia and PBT significantly decreased OS in univariate analysis. Although PBT was needed more frequently by older patients in worse physical conditions with more advanced HNSCC, subgroup analysis also demonstrate a profoundly negative effect of PBT on OS in younger patients and early stage HNSCC. According to a restrictive transfusion policy at our hospital the transfusion rate was comparably low. We could not verify increasing effects of PBT on cancer recurrence rates as it was previously shown.DiscussionPreoperative anemia is the most common paraneoplastic syndrome in HNSCC. Despite its devastating prognostic effect we suggest a restrictive transfusion policy whenever possible. Our data also show that anemia as an independent prognostic factor in head and neck surgical oncology is defined not only by low hemoglobin concentrations but low red blood cell counts as well.
Highlights
There is an increasing awareness of the negative effects of blood products in cancer treatment [1]
Because in our study perioperative blood transfusion (PBT) was more frequently needed by older patients, patients in worse physical conditions, anemic patients, patients with p16-negative and more advanced pT- and pathological lymph node (pN-)stage head and neck squamous cell carcinoma (HNSCC), we suggest that these factors contributed to the significance of PBT in univariate analysis of overall survival (OS)
Unlike all other factors analyzed for their impact on survival in this study, pre- and perioperative anemia is a potential aim of therapeutic intervention
Summary
There is an increasing awareness of the negative effects of blood products in cancer treatment [1]. Once considered as a benign intervention, perioperative blood transfusion (PBT) is nowadays recognized as a measure that should be avoided if possible. Several processes that occur during and after transfusion are discussed as causes for its adverse effects in surgical oncology. Units of red blood cells contain lipids and a variety of proinflammatory mediators like phosphatidylcholines and eicosanoids, as well as microparticles containing numerous growth factors [6, 7, 8]. The immunomodulatory effects of allogeneic blood transfusions include a decrease of interleukin 2 secretion, a diminished activity of natural killer cells and macrophages, as well as hypersensitivity reaction. On the other hand, mounting evidence shows that it negatively affects patient‘s immune surveillance of cancer and promotes tumor growth and dissemination [4, 8]
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