Blood transfusions may adversely affect survival outcomes of patients with lung cancer: a systematic review and meta-analysis

Cho, Sukjoo; Park, Jonghanne; Lee, Misuk; Lee, Dongyup; Choi, Horyun; Gim, Gahyun; Kim, Leeseul; Kang, Cyra Y.; Oh, Youjin; Viveiros, Pedro Hermida de; Vagia, Elena; Oh, Michael S.; Cho, Geum Joon; Bharat, Ankit; Chae, Young Kwang

doi:10.21037/tlcr-20-933

Cited by 7 publications

(6 citation statements)

References 87 publications

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“…In addition, preoperative anaemia has been associated with an increased incidence of receiving perioperative transfusions, which is also linked to increased postoperative morbidity and mortality [2]. Cho et al [10] showed that blood transfusions in patients with lung cancer decreases overall survival and disease-free survival in a large meta-analysis of 12 175 patients that included perioperative transfusion data. Worse overall survival, disease-free survival and recurrence were noted in a dose-dependent relationship with increasing units of blood transfusions above a single unit in a study by Jawad Latif et al [11].…”

Section: Why Anaemia Is Harmfulmentioning

confidence: 99%

Current concepts in evaluation and management of preoperative anaemia in patients undergoing thoracic surgery

Lanigan

Wilkey²

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThe purpose of this review is to evaluate the current recommendations for management of perioperative anaemia in patients undergoing thoracic surgery, present the impact of anaemia on outcomes in this patient population and suggest an algorithm for evaluating and treating anaemia preoperatively. Recent findingsAnaemia is a common medical issue noted preoperatively in patients presenting for thoracic surgery and carries significant morbidity. Preoperative anaemia increases the likelihood of receiving a perioperative transfusion, which represents a significant risk factor for morbidity and reduced disease-free survival in lung cancer patients presenting for thoracic surgery. It is also associated with longer hospital lengths of stay and increased risk for reoperation following lung transplantation. An algorithm-based approach to management of anaemia is beneficial and treatment with iron has been shown to reduce transfusions. SummaryPatients undergoing thoracic surgery have a high incidence of preoperative anaemia that increases the risk of transfusion and postoperative morbidity. Preoperative evaluation and tailored treatment based on the underlying cause of anaemia reduces the incidence of anaemia prior to surgery and decreases transfusion rates.

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Section: Why Anaemia Is Harmfulmentioning

confidence: 99%

Current concepts in evaluation and management of preoperative anaemia in patients undergoing thoracic surgery

Lanigan

Wilkey²

2022

Current Opinion in Anaesthesiology

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“…However, the speed of RCTs is hampered by ethical issues, narrow patient and procedural spectra, and studies using xed thresholds [5]. Nevertheless, numerous observational studies have been conducted on surgical patients with cancer, such as those with lung, stomach, colorectal, and bladder cancer, to understand the effects of transfusion on patient outcomes [9][10][11]. Most of these observational studies have linked perioperative transfusion to adverse surgical outcomes and worse prognosis whereas no such effects have been seen in RCTs.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of a Restrictive Transfusion Strategy for Patients Undergoing Malignant Tumour Resection: A Multicentre Prospective Observational Study

Yu,

Chen,

Wang

et al. 2024

Preprint

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Background The recommended transfusion threshold for surgical oncology patients remains unclear owing to insufficient evidence from randomized controlled trials. Evidence from observational studies has been questioned because of huge patient heterogeneity. We aimed to assess the safety of restrictive transfusion at a minimum tolerable haemoglobin threshold for surgical oncology patients with observational data using a tailored design and analysis. Methods Data were collected from four representative regional hospitals in China during 2015 − 2016. Surgical inpatients with seven types of cancer (total cancers) comprised 6055 participants as the base population. In our design, we (1) derived a primary analytic sample by the interested zone of transfusion decision: 6–10 g/dL; (2) selected the control group according to trigger haemoglobin threshold; (3) evaluated the patient heterogeneity between the transfused and non-transfused groups with key covariates according to standardized mean difference (SMD) values. Analysis is mainly based on two datasets: The base population to obtain a natural pattern of transfusion practice; and the primary analytic sample to evaluate the safety of a restrictive transfusion strategy. Results In the base population, 836 (13.81%) were transfused and showed high heterogeneity compared with non-transfused patients (SMD: 7.1–71.31%); there was a significant positive association between transfusion and the composite outcome (in-hospital complications and death) (P < 0.05). In the primary analytic sample, patient heterogeneity was greatly reduced (all SMD ≤ 10%). Compared with non-transfusion, transfusion no longer increased the risk of the composite outcome for total cancers at haemoglobin 6–10 g/dL (odds ratio [OR]: 1.18, 95% confidence interval [CI]: 0.71–1.98), especially for colorectal cancer at 6 − 8 g/dL (OR: 0.54, 95% CI: 0.17–1.68). Compared with those transfused at haemoglobin 8–10 g/dL, patients transfused at 6–8 g/dL did not increase the risk of the composite outcome for total cancers (OR: 1.08, 95% CI: 0.44–2.65), especially for colorectal cancer (OR: 0.46, 95% CI: 0.12–1.82). Conclusions A restrictive transfusion threshold of 8 g/dL may be feasible for total cancers, with a threshold as low as 6 g/dL for colorectal cancer. Restrictive transfusion evidence can be complemented with observational data using a tailored design and analysis.

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“…While postoperative bleeding occurs rarely in primary lung tumor surgery (1.3–2.1%) [ 1 , 2 ], ABT occurs in 9–55.4% of patients [ 3 , 4 ]. ABT carries a risk for complications, negatively impacts prognosis [ 5 ] and is limited by the availability of red blood cell (RBC) units. Therefore, preoperative identification of risk factors for perioperative ABT in lung cancer surgery might help to reduce ABT use and improve surgery outcomes [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Preoperative risk factors predict perioperative allogenic blood transfusion in patients undergoing primary lung cancer resections: a retrospective cohort study from a high-volume thoracic surgery center

et al. 2023

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Background Our study aimed to identify preoperative predictors for perioperative allogenic blood transfusion (ABT) in patients undergoing major lung cancer resections in order to improve the perioperative management of patients at risk for ABT. Methods Patients admitted between 2014 and 2016 in a high-volume thoracic surgery clinic were retrospectively evaluated in a cohort study based on a control group without ABT and the ABT group requiring packed red blood cell units within 15 days postoperatively until discharge. The association of ABT with clinically established parameters (sex, preoperative anemia, liver and coagulation function, blood groups, multilobar resections) was analyzed by contingency tables, receiver operating characteristics (ROC) and logistic regression analysis, taking into account potential covariates. Results 60 out of 529 patients (11.3%) required ABT. N1 and non-T1 tumors, thoracotomy approach, multilobar resections, thoracic wall resections and Rhesus negativity were more frequent in the ABT group. In multivariable analyses, female sex, preoperative anemia, multilobar resections, as well as serum alanine-aminotransferase levels, thrombocyte counts and Rhesus negativity were identified as independent predictors of ABT, being associated with OR (95% Confidence interval, p-value) of 2.44 (1.23–4.88, p = 0.0112), 18.16 (8.73–37.78, p < 0.0001), 5.79 (2.50–13.38, p < 0.0001), 3.98 (1.73–9.16, p = 0.0012), 2.04 (1.04–4.02, p = 0.0390) and 2.84 (1.23–6.59, p = 0.0150), respectively. Conclusions In patients undergoing major lung cancer resections, multiple independent risk factors for perioperative ABT apart from preoperative anemia and multilobar resections were identified. Assessment of these predictors might help to identify high risk patients preoperatively and to improve the strategies that reduce perioperative ABT.

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Blood transfusions may adversely affect survival outcomes of patients with lung cancer: a systematic review and meta-analysis

Cited by 7 publications

References 87 publications

Current concepts in evaluation and management of preoperative anaemia in patients undergoing thoracic surgery

Current concepts in evaluation and management of preoperative anaemia in patients undergoing thoracic surgery

Feasibility of a Restrictive Transfusion Strategy for Patients Undergoing Malignant Tumour Resection: A Multicentre Prospective Observational Study

Preoperative risk factors predict perioperative allogenic blood transfusion in patients undergoing primary lung cancer resections: a retrospective cohort study from a high-volume thoracic surgery center

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