Impact of perioperative red blood cell transfusion, anemia of cancer and global health status on the prognosis of elderly patients with endometrial and ovarian cancer

Abstract

Introduction: Perioperative red blood cell (RBC) transfusions have been associated with increased morbidity and worse oncological outcome in some solid neoplasms. In order to elucidate whether RBC transfusions themselves, the preoperative anemia of cancer (AOC), or the impaired global health status might explain this impact on patients with endometrial cancer (EC) or ovarian cancer (OC), we performed a retrospective, single-institution cohort study.Materials and methods: Women older than 60 years with EC or OC were included. The influence of RBC transfusions, AOC, and frailty status determined by the G8 geriatric screening tool (G8 score), as well as the clinicalpathological cancer characteristics on progression-free survival (PFS) and overall survival (OS), was determined by using the Kaplan-Meier method and the Cox regression analyses.Results: In total, 263 patients with EC (n = 152) and OC (n = 111) were included in the study. Patients with EC receiving RBC transfusions were faced with a significantly shorter 5-year PFS (79.8% vs. 26.0%; p < 0.001) and 5-year OS (82.6% vs. 25.7%; p < 0.001). In multivariable analyses, besides established clinical-pathological cancer characteristics, the RBC transfusions remained the only significant prognostic parameter for PFS (HR: 1.76; 95%-CI [1.01-3.07]) and OS (HR: 2.38;). In OC, the G8 score stratified the cohort Frontiers in Oncology frontiersin.org 01

Development of prediction model to estimate future risk of ovarian lesions: A multi-center retrospective study

“…Next, age, MLR and RBC are more important predictors besides the serum tumor index in the RFM but not statistically significant in the LLRM, indicating that machine learning is more powerful than clinical statistical prediction in the background of big data, which can identify the main indicators that can not be identified by statistically logistic. Katharina Anic proposed perioperative RBC transfusions have been associated with increased morbidity in some solid neoplasms ( Anic et al, 2022 ). Eiryo Kawakami proved that age was a critical variable in discriminating ovarian benign and malignant tumors ( Kawakami et al, 2019 ).…”

Laparoscopic Surgery for Ovarian Neoplasms – What is Possible, What is Useful?

“…The question of whether the malignancy can be fully resected becomes more complicated the more advanced the ovarian carcinoma is at the time of diagnosis (from FIGO stage IIIC to IV). Furthermore, a poor general condition or the presence of multiple comorbidities, as well as the patient’s age, are all factors that may make it more difficult to achieve the optimum surgical result of completely resecting the tumor 73 74 . Patients who have a high perioperative risk or for whom the likelihood of an optimal tumor debulking operation is very low can first receive neoadjuvant chemotherapy before subsequently undergoing interval debulking surgery 75 .…”

“…Außerdem stellen ein eingeschränkter Allgemeinzustand bzw. das Vorhandensein multipler prognosebeeinflussender Komorbiditäten und das Alter der Patientin Faktoren dar, welche ein optimales Operationsergebnis im Sinne einer Komplettresektion des Tumors erschweren können 73 74 . Patientinnen, die ein hohes perioperatives Risiko haben oder bei denen die Wahrscheinlichkeit für eine optimale Tumordebulking-Operation sehr gering ist, können zunächst eine neoadjuvante Chemotherapie erhalten, bevor anschließend ein Intervall-Debulking angestrebt wird 75 .…”

Predictive Role of Pre-Operative Anemia in Early Recurrence of Endometrial Cancer: A Single-Center Study in Romania

“…Erythropoiesis-stimulating agents (ESAs), intravenous (IV) or oral iron preparations, red blood cell (RBC) transfusions, and combinations of these therapies are used to treat anemia associated with cancer [20,21]. On the other hand, additional study indicates that red cell transfusions have a negative impact on endometrial cancer patients' prognosis [22].…”