Abstract
Whether blood transfusion exacerbates cancer outcomes after surgery in humans remains inconclusive. We utilized a large cohort to investigate the effect of perioperative blood transfusion on cancer prognosis following colorectal cancer (CRC) resection. Patients with stage I through III CRC undergoing tumour resection at a tertiary medical center between 2005 and 2014 were identified and evaluated through August 2016. Propensity score matching was used to cancel out imbalances in patient characteristics. Postoperative disease-free survival (DFS) and overall survival (OS) were analysed using Cox regression model. A total of 4,030 and 972 patients were analysed before and after propensity score matching. Cox regression analyses demonstrated blood transfusion associated with shorter DFS and OS before and after matching (hazard ratio: 1.41, 95% CI: 1.2–1.66 for DFS; 1.97, 95% CI: 1.6–2.43 for OS). Larger transfusion volume was linked to higher overall mortality (≤4 units vs. nil, HR = 1.58; >4 units vs. nil, HR = 2.32) but not more cancer recurrence. Preoperative anemia was not associated with decreased survival after adjusting covariates. Perioperative blood transfusion was associated with worse cancer prognosis after curative colorectal resection, independently of anemia status. Strategies aimed at minimizing transfusion requirements should be further developed.
Highlights
Diabetes Coronary artery disease Heart failure Stroke Chronic kidney disease Pretreatment carcinoembryonic antigen (CEA), μg·L−1 Hemoglobin conc., g·dL−1 Platelet count, 103·μL−1 international normalized ratio (INR) > 1 Tumour location, left-sided Epidural block Anaesthesia time, min Laparoscopic surgery Preoperative C/T ± R/T Postoperative C/T (
Whether perioperative blood transfusions have a deleterious effect on cancer recurrence or survival remains a controversial issue
To evaluate whether increased incidence of tumour recurrence is causally related to the blood transfusions, one should consider various important confounding factors, including preoperative functional status, the presence of preoperative anemia, tumour stage and type, duration and type of anaesthesia, etc[5]
Summary
Diabetes Coronary artery disease Heart failure Stroke Chronic kidney disease Pretreatment CEA, μg·L−1 Hemoglobin conc., g·dL−1 Platelet count, 103·μL−1 INR > 1 Tumour location, left-sided Epidural block Anaesthesia time, min Laparoscopic surgery Preoperative C/T ± R/T Postoperative C/T (
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