Perioperative blood transfusion has distinct postsurgical oncologic impact on patients with different stage of hepatocellular carcinoma

Abstract

Background: The influence of perioperative blood transfusion (PBT) on postsurgical survival of patients with different stage of hepatocellular carcinoma (HCC) is not well clarified. This study aimed to evaluate the impact of PBT on survival outcomes of different stage of HCC patients. Methods: Consecutive patients who underwent liver resection for HCC between January 2009 and November 2015 were identified from an HCC prospective database in authors' center. The survival outcomes were compared between patients receiving PBT and those without PBT before and after propensity score matching (PSM) in different stage subsets. Cox regression analysis was performed to verify the impact of PBT on outcomes of HCC. Results: Among 1255 patients included, 804 (64.1%) were Barcelona Clinic Liver Cancer (BCLC) stage 0-A, and 347 (27.6%) received PBT. Before PSM, patients with PBT had worse disease free survival (DFS) and overall survival (OS) compared with those without PBT in both BCLC 0-A subset and BCLC B-C subset (all P < 0.05). After PSM, 288 pairs of patients (with and without PBT) were created. In the subset of BCLC 0-A, the median DFS of patients with PBT was shorter than those without PBT (12.0 months vs. 36.0 months, P = 0.001) Similar result was observed for OS (36.0 months vs. 96.0 months, P = 0.001). In the subset of BCLC B-C, both DFS and OS were comparable between patients with PBT and those without PBT. Cox regression analysis showed that PBT involved an increasing risk of DFS (HR = 1.607; P < 0.001) and OS (HR = 1.756; P < 0.001) for this subset. However, PBT had no impact on DFS (P = 0.126) or OS (P = 0.139) for those with stage B-C HCC. Conclusions: PBT negatively influenced oncologic outcomes of patient with BCLC stage 0-A HCC, but not those with stage B-C after curative resection.

Effect of Perioperative Blood Transfusion on the Postoperative Prognosis of Ruptured Hepatocellular Carcinoma Patients With Different BCLC Stages: A Propensity Score Matching Analysis

“…In the survival curve obtained after PSM, we could see that in the BCLC-A group, the survival prognosis of the PBT group was significantly worse than that of the nonPBT group, while in the BCLC-BC group, the survival curve of the PBT group was not statistically different from that of the nonPBT group. This is consistent with the conclusion of Chen et al ( 17 ), but our study focuses on rHCC patients and can provide better guidance for rHCC patients.…”

“…We also noted that patients in the PBT group had complex tumor presentation. Some researchers also believed that some tumor characteristics such as tumor size and related manifestations such as venous tumor thrombus were risk factors for blood transfusion and blood loss ( 17 , 20 , 32 ). At present, for the definition of blood loss and blood transfusion in clinical practice, it is controversial whether blood loss affects the prognosis of patients ( 17 , 33 ) andwhether the presence of rupture necessarily means that there is more blood loss, due to which a higher transfusion volume is not conclusive.…”

“…Some researchers also believed that some tumor characteristics such as tumor size and related manifestations such as venous tumor thrombus were risk factors for blood transfusion and blood loss ( 17 , 20 , 32 ). At present, for the definition of blood loss and blood transfusion in clinical practice, it is controversial whether blood loss affects the prognosis of patients ( 17 , 33 ) andwhether the presence of rupture necessarily means that there is more blood loss, due to which a higher transfusion volume is not conclusive. Tumors inside the liver may not have significant blood loss compared to tumors in the periphery of the liver, and estimation of blood loss during hepatectomy in clinical work is also limited.…”

ERAS Protocol for Perioperative Care of Patients Treated with Laparoscopic Nonanatomic Liver Resection for Hepatocellular Carcinoma: The ISMETT Experience

“…[19][20][21][22][23][24] In the international scientific literature of reference, it is well understood how to identify the best surgical procedure by analyzing clear clinical outcomes both in the setting of hepatobiliary surgery and in liver transplantation. [25][26][27][28][29][30] Otherwise, LR is a valid therapeutic strategy for elderly patients, who cannot be referred to a transplant program because of the potential severe complications associated with transplantation. In contrast, ESLD may limit interventional options to HCC treatment, influence pharmacokinetics of anticancer drugs, and render patients susceptible to hepatotoxicity, adding a risk for morbidity and mortality.…”

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

“…Second, the conclusions drawn based on the total cohort did not apply to an individual, as the patients had tumors of different stages. Previous studies on hepatocellular carcinoma showed PBT to have different impact on long-term survival in different tumor stages (11,12). However, the impact of PBT on long-term survival has not been studied in patients with different stages of pCCA.…”