Influence of perioperative blood transfusion on the prognosis of patients with gastric cancer receiving anticancer chemotherapy

Abstract

BACKGROUND: The deleterious effect of blood transfusions on survival has been reported in patients with cancers of various organs. However, it remains unclear whether there is any adverse effect of blood transfusion when the patients are administered anticancer drugs after surgery for gastric cancers.METHODS: Data from patients with gastric resection for advanced gastric cancer were retrospectively analyzed to determine the influence of perioperative blood transfusion on the survival rate. All patients were administered anticancer drugs (mitomycin C [MMC] and tegafur-uracil [UFT]). Sixty-nine (33%) of 208 patients received blood transfusion perioperatively, while 139 patients (67%) did not receive transfusion. Multivariate analysis of clinicopathologic prognostic factors, including blood transfusion, was performed. Lymphocyte subsets were measured to investigate the immunosuppressive effect of blood transfusion.RESULTS: The 5-year survival rate was 48.8% in the 69 transfused patients and 66.9% in the 139 non-transfused patients ( P < 0.01). Cox's multiple regression analysis showed that, when patients received anticancer drugs, perioperative blood transfusion was not a significant factor affecting survival after the gastric cancer surgery. However, the CD4/CD8 ratio at 3 months after the surgery was significantly lower in the transfused group than in the non-transfused group.CONCLUSION: Blood transfusion did not affect the survival of operated patients who received postoperative adjuvant chemotherapy. However, the finding that the ratio of CD4/CD8 after surgery was significantly higher in the non-transfused group than in the transfused group supports the notion that transfusion causes broad-spectrum immunosuppression.

Intravenous delivery of the plasma fraction of stored packed erythrocytes promotes pancreatic cancer growth in immunocompetent mice

“…This study has demonstrated that the acellular plasma fraction from stored packed erythrocytes promotes cellular proliferation, and Pan02 migration (surrogates for cancer growth and metastasis) promotes in vivo pancreatic cancer growth. Although previous clinical studies have shown similar conclusions,10, 17, 18, 45 these studies are difficult to interpret given the large number of variables inherent in any cancer patient population, including tumor biology, tumor stage, and untoward events during surgery, as well as innumerable host factors. Use of this well‐established immunocompetent model of pancreatic cancer29 has allowed us to control for many factors that cause clinical trials to be dismissed.…”

Perioperative Blood Transfusion, Age at Surgery, and Prognosis in a Database of 526 Upper Gastrointestinal Cancers

“…In patients with gastric cancer, the postoperative 5-year survival rates are reportedly 49-65% for transfused patients and 62-77% for non-transfused patients (p < 0.05) [10,11] . However, some studies have reported that there was no association between perioperative blood transfusion and prognosis [12][13][14][15] . In this study, the OS and DFS of patients who received perioperative blood transfusions was significantly shorter than that of patients who did not.…”

“…Previous data on blood transfusion and clinical outcome in upper gastrointestinal cancers are inconclusive. Some studies have shown an association between perioperative blood transfusion and poor prognosis [10], whereas others have reported no such relationship [11][12][13][14][15] . Postulated explanations for a relationship between perioperative blood transfusion and poor prognosis have included transfusion-related immunomodulation: immunosuppressive or proinflammatory changes [16] .…”

Factors Influencing Perioperative Blood Transfusions in Patients with Gastrointestinal Cancer

“…A reduced overall survival after TFs for patients undergoing resections of pancreatic [12], gastric [11], or colorectal cancer [35] was not detected in other studies of patients with similar diagnoses [31,36,37]. In an observational analysis of a prospective trial of patients undergoing colorectal cancer resections, TF led to a reduction in overall survival, but not in cancer recurrence rate [14].…”

“…Contemporary hepatectomy-related PRBC transfusion rates have been described as 35% [29], 34% [3], 17% (since 1995) [6], or 11% [30], compared with 16% in this experience. TF rates after gastrectomy are 35% [11] or 33% [31] in recent reports, compared with 30% in this series; TF rates after esophagectomy (33% in this report) may be higher, such as 46% [10]. The category of "other" resections in our analysis includes lower-risk procedures such as large bowel resections (TF rate: 14%) as well as complex procedures for which specific surgical oncology input was requested in consultation, which precludes a conclusive analysis of this heterogeneous subgroup.…”