Association Of Perioperative Blood Transfusion Research Articles

The association of perioperative blood transfusion with survival outcomes after major cancer surgery: a population-based cohort study in South Korea.

The correlation between perioperative blood transfusions and the prognosis after major cancer surgery remains controversial. We investigated the association between perioperative blood transfusion and survival outcomes following major cancer surgeries and analyzed trends in perioperative blood transfusions. Data for this population-based cohort study were obtained from the National Health Insurance Service of South Korea. Adult patients who underwent major cancer surgery between January 1, 2016, and December 31, 2020, were included. The primary endpoint was 90-day mortality. The final analysis included 253,016 patients, of which 55,094 (21.8%) received perioperative blood transfusions. In the multivariable logistic regression model, select factors, including neoadjuvant/adjuvant chemotherapy, an increased preoperative Charlson Comorbidity Index, moderate or severe liver disease, liver cancer surgery, and small bowel cancer surgery, were associated with an increased likelihood of blood transfusion. In the multivariable Cox regression model, patients who received blood transfusion had a significantly higher risk of 90-day mortality (hazard ratio: 5.68; 95% confidence interval: 5.37, 6.00; P < 0.001) than those who did not. We identified potential risk factors for perioperative blood transfusions. Blood transfusion is associated with an increased 90-day mortality risk after major cancer surgery.

Impact of perioperative blood transfusion on long-term survival in patients with different stages of perihilar cholangiocarcinoma treated with curative resection: A multicentre propensity score matching study.

The association of perioperative blood transfusion (PBT) with long-term survival in perihilar cholangiocarcinoma (pCCA) patients after surgical resection with curative intent is controversial and may differ among different stages of the disease. This study aimed to investigate the impact of PBT on long-term survival of patients with different stages of pCCA. Consecutive pCCA patients from three hospitals treated with curative resection from 2012 to 2019 were enrolled and divided into the PBT and non-PBT groups. Propensity score matching (PSM) was used to balance differences in baseline characteristics between the PBT and non-PBT groups. Kaplan-Meier curves and log-rank test were used to compare overall survival (OS) and recurrence-free survival (RFS) between patients with all tumor stages, early stage (8th AJCC stage I), and non-early stage (8th AJCC stage II-IV) pCCA in the PBT and non-PBT groups. Cox regression analysis was used to determine the impact of PBT on OS and RFS of these patients. 302 pCCA patients treated with curative resection were enrolled into this study. Before PSM, 68 patients (22 patients in the PBT group) were in the early stage and 234 patients (108 patients in the PBT group) were in the non-early stage. Patients with early stage pCCA in the PBT group had significantly lower OS and RFS rates than those in the non-PBT group. However, there were with no significant differences between the 2 groups with all tumor stages and non-early stage pCCA. After PSM, there were 18 matched pairs of patients with early stage and 72 matched pairs of patients with non-early stage. Similar results were obtained in the pre- and post-PSM cohorts: patients with early stage pCCA in the PBT group showed significantly lower OS and RFS rates than those in the non-PBT group, but there were no significant differences between the 2 groups for patients with all tumor stages and non-early stage pCCA. Cox regression analysis demonstrated that PBT was independently associated with worse OS and RFS for patients with early stage pCCA. PBT had a negative impact on long-term survival in patients with early stage pCCA after curative resection, but not in patients with non-early stage pCCA.

Perioperative Blood Transfusion as a Significant Predictor of Biochemical Recurrence and Survival after Radical Prostatectomy in Patients with Prostate Cancer.

PurposeThere have been conflicting reports regarding the association of perioperative blood transfusion (PBT) with oncologic outcomes including recurrence rates and survival outcomes in prostate cancer. We aimed to evaluate whether perioperative blood transfusion (PBT) affects biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS) following radical prostatectomy (RP) for patients with prostate cancer.Materials and MethodsA total of 2,713 patients who underwent RP for clinically localized prostate cancer between 1993 and 2014 were retrospectively analyzed. We performed a comparative analysis based on receipt of transfusion (PBT group vs. no-PBT group) and transfusion type (autologous PBT vs. allogeneic PBT). Univariate and multivariate Cox-proportional hazard regression analysis were performed to evaluate variables associated with BRFS, CSS, and OS. The Kaplan-Meier method was used to calculate survival estimates for BRFS, CSS, and OS, and log-rank test was used to conduct comparisons between the groups.ResultsThe number of patients who received PBT was 440 (16.5%). Among these patients, 350 (79.5%) received allogeneic transfusion and the other 90 (20.5%) received autologous transfusion. In a multivariate analysis, allogeneic PBT was found to be statistically significant predictors of BRFS, CSS, and OS; conversely, autologous PBT was not. The Kaplan-Meier survival analysis showed significantly decreased 5-year BRFS (79.2% vs. 70.1%, log-rank, p = 0.001), CSS (98.5% vs. 96.7%, log-rank, p = 0.012), and OS (95.5% vs. 90.6%, log-rank, p < 0.001) in the allogeneic PBT group compared to the no-allogeneic PBT group. In the autologous PBT group, however, none of these were statistically significant compared to the no-autologous PBT group.ConclusionsWe found that allogeneic PBT was significantly associated with decreased BRFS, CSS, and OS. This provides further support for the immunomodulation hypothesis for allogeneic PBT.

Association between Perioperative Blood Transfusion and Oncologic Outcomes after Curative Surgery for Renal Cell Carcinoma.

Purpose: We aimed to elucidate the association between perioperative blood transfusion (PBT) and the prognosis of patients undergoing curative surgery for renal cell carcinoma (RCC).Methods: In all, 3,832 patients with RCC who had undergone curative surgery were included in this study from a multicenter database. PBT was defined as the transfusion of packed red blood cells within seven days before surgery, during surgery, or within the postoperative hospitalization period. The association of PBT with oncologic outcomes was evaluated using univariate and multivariate Cox regression analyses, and regression adjustment with propensity score matching.Results: Overall, 11.7% (447/3,832) of patients received PBT. Patients receiving PBT were significantly older at diagnosis, and had lower BMI, higher comorbidities, worse ECOG performance status, and more initial symptoms. Moreover, higher pathologic TNM stage, larger mass size, higher nuclear grade, more sarcomatoid differentiation, and more tumor necrosis were all observed more frequently in patients who received PBT. In univariate analysis, relapse-free survival, cancer-specific survival, and overall survival rates were worse in patients who received PBT; however, these factors became insignificant in the matched pairs after propensity score matching. On multivariate Cox regression analysis and regression adjustment with propensity score matching, significant prognostic effects of PBT on disease relapse, cancer-specific mortality, and all-cause mortality were not observed.Conclusions: This multicenter database analysis demonstrates no significant prognostic association between PBT and oncologic outcomes in patients with RCC.

Effect of perioperative blood transfusion on the prognosis of gastric cancer

To explore the association of perioperative blood transfusion (PBT) with survival of gastric cancer after surgery. We retrospectively reviewed the medical records of 1 000 gastric cancer patients, including 738 non-transfused (73.8%) and 262 transfused (26.2%) cases. A one to one match was created using propensity score analysis, except preoperative hemoglobin level and operative blood loss. The survival was analyzed by Kaplan-Meier survival model. The 5-year survival rate of the 1 000 cases of gastric cancer patients was 39.9%. Before matching, there was a significant difference between transfused group (33.6%) and non-transfused group (49.1%, P<0.005). Univariate analysis showed that age, tumor size, hemoglobin level, albumin level, depth of invasion, lymph node metastasis, lymph node dissection, surgery mode, adjuvant chemotherapy, blood loss and blood transfusion during perioperative period were associated with prognosis in the gastric cancer patients (all P<0.05). Multivariate analysis showed that tumor invasion, lymph node metastasis, lymph node dissection, chemotherapy and perioperative blood transfusion were independent prognostic factors in gastric cancer (all P<0.05). After matching, the 5-year survival rate of the 262 non-transfused patients was 37.7%, while that of the 262 transfused patients was 33.6% (P>0.05). Perioperative blood transfusion has no significant effect on the prognosis of gastric cancer patients.

Association of perioperative blood transfusion and adverse events after operative treatment of proximal humerus fractures

BackgroundThe purpose of this study was to assess the relationship between perioperative blood transfusion for proximal humerus fracture and inpatient mortality, adverse events, prolonged hospital stay, and nonroutine disposition. MethodsAmong the >55,000 patients with an operatively treated proximal humerus fracture identified in the Nationwide Inpatient Sample between 2008 and 2011, 17% received a perioperative blood transfusion. Multivariable logistic regression analyses addressed the association of blood transfusion with inpatient mortality, adverse events, hospital stay, and nonroutine discharge, accounting for comorbidities and other known confounders. ResultsPerioperative blood transfusion for fracture of the proximal humerus was not associated with inhospital death, but it was independently associated with inpatient adverse events (odds ratio (OR) 4.4, 95% confidence interval (CI) 4.2–4.6), prolonged hospital stay (OR 2.8, 95% CI 2.7–2.9), and increased nonroutine discharge (OR 1.8, 95% CI 1.7–1.9). ConclusionsInpatients with fracture of the proximal humerus who receive transfusion are not more likely to die in hospital, but they do stay longer, experience more adverse events, and are less likely to be discharged home. Additional study is merited to determine if the judicious use of blood transfusion in the perioperative period can decrease inpatient morbidity and health-care resource utilisation. Level of evidenceLevel II, Retrospective Design, Prognosis Study.

Association of perioperative blood transfusion with oncologic outcomes after radical nephroureterectomy for upper tract urothelial carcinoma

BackgroundTo test the hypothesis that perioperative blood transfusion (PBT)impacts oncologic outcomes of patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). MethodsRetrospective analysis of 2492 patients with UTUC treated at 23 institutions with RNU between 1987 and 2007.Cox regression models addressed the association of PBT with disease recurrence, cancer-specific mortality and any-cause mortality. ResultsA total of 510 patients (20.5%) patients received PBT. Within a median follow-up of 36 months (Interquartile range: 55 months), 663 (26.6%) patients experienced disease recurrence, 545 patients (21.9%) died of UTUC and 884 (35.5%) patients died from any cause. Patients who received PBT were at significantly higher risk of disease recurrence, cancer-specific mortality and overall mortality than patients not receiving PBT in univariable Cox regression analyses. In multivariable Cox regression analyses that adjusted for the effects of standard clinicopathologic features, PBT did not remain associated with disease recurrence (HR: 1.11; 95% CI 0.92–1.33, p = 0.25), cancer-specific mortality (HR: 1.09; 95% CI 0.89–1.33, p = 0.41) or overall mortality (HR: 1.09; 95% CI 0.93–1.28, p = 0.29). ConclusionsIn patients undergoing RNU for UTUC, PBT is associated with disease recurrence, cancer-specific survival or overall survival in univariable, but not in multivariable Cox regression analyses.

21 Association of perioperative blood transfusion with oncologic outcomes after radical nephroureterectomy for upper tract urothelial carcinoma

21 Association of perioperative blood transfusion with oncologic outcomes after radical nephroureterectomy for upper tract urothelial carcinoma

PD16-03 THE IMPACT OF PERIOPERATIVE BLOOD TRANSFUSION ON SURVIVAL FOLLOWING NEPHRECTOMY FOR NON METASTATIC RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 2014PD16-03 THE IMPACT OF PERIOPERATIVE BLOOD TRANSFUSION ON SURVIVAL FOLLOWING NEPHRECTOMY FOR NON METASTATIC RENAL CELL CARCINOMA Brian Linder, R. Houston Thompson, Bradley Leibovich, John Cheville, Christine Lohse, Dennis Gastineau, and Stephen Boorjian Brian LinderBrian Linder More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Bradley LeibovichBradley Leibovich More articles by this author , John ChevilleJohn Cheville More articles by this author , Christine LohseChristine Lohse More articles by this author , Dennis GastineauDennis Gastineau More articles by this author , and Stephen BoorjianStephen Boorjian More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1148AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives While receipt of a perioperative blood transfusion (PBT) has been associated with an increased risk of mortality for a number of cancers, the relationship between PBT and survival following nephrectomy for kidney cancer has not been well established. Determining the impact of PBT on postoperative outcomes is important for optimizing patient management. Herein, we evaluated the association of perioperative blood transfusion with survival following nephrectomy for renal cell carcinoma (RCC). Methods We identified 2318 patients who underwent partial or radical nephrectomy at Mayo Clinic between 1990 and 2006 for non-metastatic RCC. PBT was defined as transfusion of allogenic red blood cells during surgery or postoperative hospitalization. Survival was estimated using Kaplan Meier method and compared with the log−rank test. Cox proportional hazards regression models were used to evaluate the association of PBT with outcome. Results A total of 498 patients (21%) received a PBT. The median number of units transfused was 3 (IQR 2, 5). Patients receiving a PBT were significantly older at surgery (p<0.001), more likely to be female (p<0.001), with more frequent symptomatic presentation (p<0.001), worse ECOG performance status (p<0.001), and more frequent adverse pathologic features such as high nuclear grade (p<0.001), locally-advanced tumor stage (p<0.001) and lymph node invasion (p<0.001). Median postoperative follow−up was 9.1 years. Receipt of a PBT was associated with adverse 5 year cancer−specific (68% versus 92%;p<0.001) and overall (56% versus 82%;p<0.001) survival. On multivariate analysis (Table), PBT remained associated with a higher risk of death from any cause (HR 1.23;p=0.02). Moreover, among patients who received a PBT, an increasing number of units transfused was independently associated with increased all-cause mortality (HR 1.08; p=0.001). Conclusions PBT is associated with a significantly increased risk of mortality following nephrectomy. While external validation is needed, continued efforts to minimize the use of blood products in these patients are warranted. Multivariate analysis of factors associated with death from kidney cancer and all-cause mortality following nephrectomy for RCC Death from Any Cause Death from Kidney Cancer Variable HR 95% CI p-value HR 95% CI p-value Year of surgery 0.98 0.97, 1.00 0.03 0.95 0.93, 0.98 < 0.001 Age at surgery 1.63 1.53, 1.75 < 0.001 1.14 1.03, 1.27 0.02 Gender (ref male) 1.27 1.09, 1.48 0.002 0.85 0.66, 1.09 0.2 Symptomatic presentation 1.17 0.98, 1.39 0.08 1.24 0.95, 1.62 0.12 ECOG performance status (ref 0) 2.26 1.89, 2.71 < 0.001 1.96 1.40, 2.73 < 0.001 Body mass index 1.02 0.95, 1.09 0.58 1.01 0.91, 1.13 0.82 Pre-operative hemoglobin 0.96 0.93, 1.00 0.07 1.04 0.98, 1.11 0.16 Receipt of PBT 1.23 1.04, 1.46 0.02 1.15 0.87, 1.53 0.31 Pathologic tumor stage 1.07 1.01, 1.13 0.02 1.32 1.22, 1.42 < 0.001 Tumor size 1.02 1.00, 1.05 0.06 1.04 1.00, 1.07 0.03 Histology (ref papillary/chromophobe) 1.41 1.18, 1.68 < 0.001 2.25 1.53, 3.29 < 0.001 pN1 1.91 1.39, 2.62 < 0.001 2.13 1.48, 3.05 < 0.001 Nuclear grade (ref 1-2) 3 1.30 1.11, 1.53 0.002 2.99 2.13, 4.19 < 0.001 4 2.21 1.58, 3.10 < 0.001 4.80 2.89, 7.95 < 0.001 Coagulative tumor necrosis 1.46 1.23, 1.74 < 0.001 2.26 1.73, 2.95 < 0.001 Sarcomatoid differentiation 1.69 1.08, 2.65 0.02 1.59 0.96, 2.64 0.08 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e487 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Brian Linder More articles by this author R. Houston Thompson More articles by this author Bradley Leibovich More articles by this author John Cheville More articles by this author Christine Lohse More articles by this author Dennis Gastineau More articles by this author Stephen Boorjian More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The impact of perioperative blood transfusion on survival after nephrectomy for non‐metastatic renal cell carcinoma (RCC)

To evaluate the association of perioperative blood transfusion (PBT) with survival after nephrectomy. We identified 2318 patients who underwent partial or radical nephrectomy at Mayo Clinic between 1990 and 2006. PBT was defined as transfusion of allogenic red blood cells during surgery or postoperative hospitalisation. Survival was estimated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards regression models were used to evaluate the association of PBT with outcome. In all, 498 patients (21%) received a PBT. The median (interquartile range) number of units transfused was 3 (2, 5). Patients receiving a PBT were significantly older at surgery (P < 0.001), more likely to be female (P < 0.001), with more frequent symptomatic presentation (P < 0.001), worse Eastern Cooperative Oncology Group performance status (P < 0.001), and more frequent adverse pathological features, such as high nuclear grade (P < 0.001), locally-advanced tumour stage (P < 0.001) and lymph node invasion (P < 0.001). The median follow-up was 9.1 years. Receipt of a PBT was associated with adverse 5-year cancer-specific (68% vs 92%; P < 0.001) and overall (56% vs 82%; P < 0.001) survival. On multivariate analyses, PBT remained associated with higher risk of death from any cause (hazard ratio [HR] 1.23; P = 0.02). Among patients who received a PBT, an increasing number of units transfused was independently associated with increased all-cause mortality (HR 1.08; P = 0.001). PBT is associated with a significantly increased risk of mortality after nephrectomy. While external validation is needed, continued efforts to minimise the use of blood products in these patients are warranted.

The association of perioperative blood transfusion with colorectal cancer recurrence.

The relationship between blood transfusion, disease-free survival, and other potential prognostic factors was prospectively studied in 339 consecutive patients with colorectal cancer. Admission and discharge hematocrit, Dukes' stage, and blood loss were significantly related to both blood transfusion and disease-free survival. Using Cox proportional hazards model, however, the association of transfusion with disease-free survival was significant (p = 0.0196) after controlling for age, sex, blood loss, procedure, tumor differentiation, stage, admission hematocrit, duration of surgery, length of the specimen, and tumor size. Dukes' stage (p < 0.0001) and blood transfusion (p < 0.0001) were the only variables independently related to disease-free survival. Forty per cent (44) of the 110 patients who received transfusions developed cancer recurrence, compared with 22% (50) of the 229 patients who did not receive blood (p < 0.0001). Five-year disease-free survival of the transfused patients was 57%, compared with 77% for nontransfused patients. Patients who developed recurrence received an average of twice as much blood as patients without recurrence (1.26 versus 0.61 units, p = 0.0128). Perioperative blood transfusion is a significant independent prognostic factor for colorectal cancer.

Blood transfusion and prognosis in colorectal carcinoma.

The association of perioperative blood transfusion and cancer recurrence was analyzed in a 10-year series of 520 patients with colorectal carcinoma undergoing curative surgery. Cancer recurrence was observed in 35 of 165 (19%) non-transfused and in 119 of 355 (34%) transfused patients (p less than 0.001). A significant difference in favor of the non-transfused group was also evident in cases of colonic (p less than 0.05) and rectal (p less than 0.01) tumors separately. The transfused group had both more recurrences and higher mortality. Although there were no differences in age, sex, and Dukes's stage between the two groups, further analysis showed other significant variables explaining the different result. First, there were significantly more patients with rectal cancer in the transfused group. In addition, emergency operations for obstruction and resections of adjacent organs for tumor invasion were significantly commoner in transfused patients. Exclusion of such patients and those with small tumors excised locally per anum resulted in the disappearance of the prognostic difference between the transfused and non-transfused groups (marginally significant difference in rectal carcinoma; p = 0.05). It is concluded that the seemingly adverse effect of blood transfusion on the prognosis of colorectal carcinoma may largely be explained by other associated variables.