Perioperative red blood cell transfusion is associated with poor functional outcome and overall survival in patients with newly diagnosed glioblastoma

Abstract

The influence of perioperative red blood cell (RBC) transfusion on prognosis of glioblastoma patients continues to be inconclusive. The aim of the present study was to evaluate the association between perioperative blood transfusion (PBT) and overall survival (OS) in patients with newly diagnosed glioblastoma. Between 2013 and 2018, 240 patients with newly diagnosed glioblastoma underwent surgical resection of intracerebral mass lesion at the authors’ institution. PBT was defined as the transfusion of RBC within 5 days from the day of surgery. The impact of PBT on overall survival was assessed using Kaplan–Meier analysis and multivariate regression analysis. Seventeen out of 240 patients (7%) with newly diagnosed glioblastoma received PBT. The overall median number of blood units transfused was 2 (95% CI 1–6). Patients who received PBT achieved a poorer median OS compared to patients without PBT (7 versus 18 months; p < 0.0001). Multivariate analysis identified “age > 65 years” (p < 0.0001, OR 6.4, 95% CI 3.3–12.3), “STR” (p = 0.001, OR 3.2, 95% CI 1.6–6.1), “unmethylated MGMT status” (p < 0.001, OR 3.3, 95% CI 1.7–6.4), and “perioperative RBC transfusion” (p = 0.01, OR 6.0, 95% CI 1.5–23.4) as significantly and independently associated with 1-year mortality. Perioperative RBC transfusion compromises survival in patients with glioblastoma indicating the need to minimize the use of transfusions at the time of surgery. Obeying evidence-based transfusion guidelines provides an opportunity to reduce transfusion rates in this population with a potentially positive effect on survival.

Unplanned intensive care unit readmission after surgical treatment in patients with newly diagnosed glioblastoma — forfeiture of surgically achieved advantages?

“…The fact that the slightest deviation from the standardized treatment protocol (e.g., prolonged mechanical ventilation) might result in a significant loss of lifetime/quality of life is therefore gaining attention [ 13 ]. Thus, it is pertinent to consider not only potential preoperative risk factors but also (adverse) treatment effects in order to be able to adapt clinical assessment/counseling/management of affected patients as well as their relatives [ 15 , 9 , 7 , 16 , 8 , 17 ].…”

Safety of Intraoperative Cell Salvage in Cancer Surgery: An Updated Meta-Analysis of the Current Literature

“…Control groups were mentioned as "no IOCS use" without further details (n = 1,116) or specified as allogeneic transfusion (n = 16), PAD with or without allogeneic blood (n = 140) or no transfusion necessary (n = 125). logic surgery [1][2][3][4][5][6]. Since a large number of studies of this meta-analysis compared patients treated with IOCS supplemented with allogeneic transfusion to groups of patients not transfused, allogeneic transfused only, or transfused with predonated autologous blood, this design is not appropriate to assess allogeneic transfusion risks.…”

“…Perioperative allogeneic red blood cell (RBC) transfusion is associated with increased mortality and cancer recurrence in multiple retrospective studies [1][2][3][4][5][6]. The underlying trials adjusted their empirical observations for confounding factors such as preoperative anemia, severity of illness, perioperative blood loss, variations in hemotherapy algorithms, and extent of surgical trauma [7].…”

Biochemical and Biophysical Properties of Red Blood Cells in Disease

“…Blood donations for transfusion are routinely stored as packed RBC (PRBC) for up to 35 or 42 days, depending on the preservation solution [ 4 ]. In the last decade, many studies have reported the negative outcome of PRBC transfusion in various groups of patients [ 5 , 6 , 7 , 8 , 9 ]. Some studies attributed this to the storage-induced lesion to RBC, while others did not find a correlation with the storage duration [ 6 , 10 , 11 , 12 ].…”