Perioperative transfusion of leukocyte depleted blood products in gastric cancer patients negatively influences oncologic outcome

Reim, Daniel; Ströbl, Andreas; Buchner, Christian; Schirren, Rebekka; Mueller, Werner; Luppa, Peter B.; Ankerst, Donna P.; Frieß, Helmut; Novotny, Alexander

doi:10.1097/md.0000000000004322

Cited by 19 publications

(14 citation statements)

References 31 publications

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“…This is reflected by beneficial survival data for individual indications, which were also in good agreement with data in the literature: Jarnagin et al (intrahepatic and perihilar cholangiocarcinoma, 63 and 69% [ 17 ]; Zaydfudim et al (hepatocellular carcinoma, 6059 [ 18 ]; Schiergens et al and Margonis et al (CRLM 68% with transfusion and 82% without transfusion) [ 15 , 19 ]; esophageal cancer (40% with transfusion vs. 60% without transfusion) [ 20 ]; gastric cancer (82 vs. 60%) [ 16 ]; and pancreatic cancer (50 to 60% vs. 20%) [ 13 , 21 ]. Last not least, Mörner et al showed that anemia and transfusions were associated with adverse outcome [ 22 ].…”

Section: Discussionsupporting

confidence: 89%

“…Sutton et al described an adverse outcome in pancreatic cancer (overall survival: 14 vs. 21 months) [ 13 ]. Other authors confirmed this for various indications: Martin et al (CRLM: odds ratio (OR) 4.18, 95% CI 2.18–8.02) and mortality (OR 14.5, 95% CI 3.08–67.8) [ 14 ], Schiergens et al (reduced recurrence-free survival (32 vs. 72 months in CRLM) [ 15 ], and Reim et al (gastric cancer: hazard ratio (HR) 1.31, 95% CI 1.01–1.69) [ 16 ]. However, these findings were based on dichotomization of data and not on the introduction of a structured program to reduce transfusions, which is the crucial difference to our work.…”

Section: Discussionmentioning

confidence: 99%

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Patient Blood Management improves outcome in oncologic surgery

et al. 2018

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BackgroundPatient Blood Management (PBM) is a systematic quality improving clinical model to reduce anemia and avoid transfusions in all kinds of clinical settings. Here, we investigated the potential of PBM in oncologic surgery and hypothesized that PBM improves 2-year overall survival (OS).MethodsRetrospective analysis of patients 2 years before and after PBM implementation. The primary endpoint was OS at 2 years after surgery. We identified a sample size of 824 to detect a 10% improvement in survival in the PBM group.ResultsThe analysis comprised of 836 patients that underwent oncologic surgery, 389 before and 447 after PBM, was implemented. Patients in the PBM+ presented significantly more frequent with normal hemoglobin values before surgery than PBM− (56.6 vs. 35.7%; p < 0.001). The number of transfusions was significantly reduced from 5.5 ± 11.1 to 3.0 ± 6.9 units/patient (p < 0.001); moreover, the percentage of patients being transfused during the clinic stay was significantly reduced from 62.4 to 40.9% (p < 0.001). Two-year OS was significantly better in the PBM+ and increased from 67.0 to 80.1% (p = 0.001). A normal hemoglobin value (> 12 g/dl in female and > 13 g/dl in male) before surgery (HR 0.43, 95% CI 0.29–0.65, p < 0.001) was the only independent predictive factor positively affecting survival.ConclusionsPBM is a quality improvement tool that is associated with better mid-term surgical oncologic outcome. The root cause for improvement is the increase of patients entering surgery with normal hemoglobin values.Electronic supplementary materialThe online version of this article (10.1186/s12957-018-1456-9) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Patient Blood Management improves outcome in oncologic surgery

et al. 2018

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“…However, our multivariate analysis showed that perioperative blood transfusion was an independent factor for increased mortality and recurrence rate. Although blood transfusion is helpful for anaemic patients, emerging evidence has clarified that it is associated with poor clinical outcomes . In CRC patients who underwent curative resections, perioperative blood transfusions showed detrimental effects on recurrence .…”

Section: Discussionmentioning

confidence: 99%

The impact of preoperative anaemia and anaemic subtype on patient outcome in colorectal cancer

et al. 2018

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“… 5 , 6 While BTF is inevitable sometimes, transfusion-related immune modulation (TRIM) and systemic inflammation induced by a BTF not only leads to a higher incidence of postoperative complications, especially infections, but also poorer prognosis. 5 – 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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confidence: 99%

Association Among Blood Transfusion, Postoperative Infectious Complications, and Cancer-Specific Survival in Patients with Stage II/III Gastric Cancer After Radical Gastrectomy: Emphasizing Benefit from Adjuvant Chemotherapy

Xiao

Xiao²,

Chen

et al. 2020

Ann Surg Oncol

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Objectives This 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. Methods The 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. Results A 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). Conclusions Infection 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.

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Perioperative transfusion of leukocyte depleted blood products in gastric cancer patients negatively influences oncologic outcome

Abstract: Supplemental Digital Content is available in the text

Cited by 19 publications

References 31 publications

Patient Blood Management improves outcome in oncologic surgery

Patient Blood Management improves outcome in oncologic surgery

The impact of preoperative anaemia and anaemic subtype on patient outcome in colorectal cancer

Association Among Blood Transfusion, Postoperative Infectious Complications, and Cancer-Specific Survival in Patients with Stage II/III Gastric Cancer After Radical Gastrectomy: Emphasizing Benefit from Adjuvant Chemotherapy

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