The Impact of Blood Transfusion on Recurrence and Mortality Following Colorectal Cancer Resection: A Propensity Score Analysis of 4,030 Patients

Wu, Hsiang Ling; Tai, Ying Hsuan; Lin, Shih Pin; Chan, Min Ya; Chen, Chien-Jen; Chang, Kuang Yi

doi:10.1038/s41598-018-31662-5

Cited by 97 publications

(89 citation statements)

References 31 publications

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“…24 Furthermore, it has been observed that modulation of the postoperative systemic inflammatory response with perioperative corticosteroids is associated with fewer postoperative complications and improved survival; however, these findings are yet to be confirmed in prospective trials. 8,9 Allogeneic blood transfusion in the perioperative period is widely thought to be negatively associated with shortterm postoperative outcomes and survival in patients undergoing surgery for cancer, with an older Cochrane review, 4 a recent large propensity score matched study of over 4000 patients, 25 and a very recent comprehensive meta-analysis 3 reporting this to be the case. However, two propensity score matched cohorts from a single group of researchers found no negative impact on survival in colon 26 or rectal cancer, 27 and a smaller recent observational study found no independent impact of blood transfusion on colorectal cancer recurrence when corrected for preoperative anemia.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer

et al. 2019

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Background. The present study investigated relationships between perioperative blood transfusion, postoperative systemic inflammatory response, and outcomes following surgery for colorectal cancer. Methods. Data were recorded for patients (n = 544) undergoing potentially curative, elective surgery for colorectal cancer at a single center between 2012 and 2017. Transfusion history was obtained retrospectively from electronic records. Associations between blood transfusion, postoperative C-reactive protein (CRP), albumin, hemoglobin, complications, cancer-specific survival and overall survival (OS) were assessed using propensity score matching (n =116). Results. Of 544 patients, the majority were male (n =294, 54%), over 65 years of age (n =350, 64%), and with colonic (n =347, 64%) node-negative disease (n =353, 65%). Eighty-six patients (16%) required perioperative blood transfusion. In the unmatched cohort, blood transfusion was associated with higher median postoperative day (POD) 3 CRP {143 [interquartile range (IQR) 96-221 mg/L] vs. 120 (IQR 72-188 mg/L); p = 0.004}, lower median POD 3 albumin [24 (IQR 20-26 g/L) vs. 27 (IQR 24-30 g/L); p \ 0.001], more postoperative complications [odds ratio (OR) 3.28, 95% confidence interval (CI) 2.03-5.29] and poorer OS [hazard ratio (HR) 3.18, 95% CI 2.08-4.84]. In the propensity score matched cohort, blood transfusion was similarly associated with higher median POD 3 CRP [130 (IQR 93-196 mg/L) vs. 113 (IQR 66-173 mg/L); p = 0.046], lower median POD 3 albumin [24 (IQR 20-26 g/L) vs. 26 (IQR 24-30 g/L); p \ 0.001], more postoperative complications (OR 2.91, 95% CI 1.36-6.20) and poorer OS (HR 2.38, 95% CI 0.99-5.73). Conclusions. Perioperative blood transfusion was associated with postoperative inflammation, complications, and poorer survival in patients undergoing colorectal cancer surgery, with and without propensity score techniques. A significant proportion of patients undergoing surgery for colorectal cancer require allogeneic blood transfusion in the perioperative period. 1 Such transfusions are associated with infective postoperative complications and anastomotic leak. 2,3 They are also associated with disease recurrence, 3,4 and this effect is even greater in the presence of infective complications. 5 Therefore, it has long been hypothesized that allogeneic blood transfusion might impair the host adaptive immune response to both pathogens and circulating or micrometastatic tumor cells. 6 There is increasing evidence that an exaggerated postoperative systemic inflammatory response following surgery for colorectal cancer is associated with postoperative complications and long-term survival. 7 Furthermore, there is some observational evidence that modulation of this response can improve both short-8 , and long-term outcomes. 9 It may be that perioperative blood transfusion and postoperative complications have a negative impact on oncologic outcomes via a common pathway, the systemic inflammatory response. 10

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Section: Discussionmentioning

confidence: 99%

Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer

et al. 2019

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“…These findings have been associated with increased tumour proliferation, apoptosis and metastasis spread [27]. Studies in patients with colorectal cancer show a similar disruption of the immune response associated with blood transfusion that is thought to control cancer spread [28,29].…”

Section: Potential Causes Of Transfusion-induced Immunementioning

confidence: 99%

The association of allogeneic blood transfusion and the recurrence of hepatic cancer after surgical resection

Tai

Wu²,

Mandell

et al. 2019

Anaesthesia

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Summary There is conflicting evidence whether allogeneic blood transfusion influences survival or cancer recurrence after resection of hepatocellular cancer. We followed up 1469 patients who had undergone hepatocellular resection for a median (IQR [range]) of 45 (21–78 [0–162]) months, of whom 626 (43%) had had blood transfusion within 7 days of surgery. Both disease‐free survival and patient survival were measured using a proportional hazards regression model and inverse probability of treatment weighting. We used restricted cubic splines for the association of the number of packed red blood cell units transfused with cancer recurrence and survival. We found that peri‐operative blood transfusion was independently associated with survival and cancer recurrence after resection of hepatocellular carcinoma. Adjusted hazard ratios (95%CI) for the association of blood transfusion with cancer recurrence and all‐cause mortality were 1.3 (1.1–1.4) and 1.9 (1.6–2.3), p < 0.001 for both. With more units transfused cancer recurrence was more likely and survival was shorter. The association of the number of transfused units was non‐linear for cancer recurrence and linear response for all‐cause mortality.

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“…In colorectal cancer patients, perioperative administration of RBC transfusion was shown to increase all-cause mortality, cancer-related mortality, combined recurrence-metastasisdeath, postoperative infection and surgical reintervention (12). In a recent large cohort study of 4000 patients, perioperative RBC transfusion was associated with worse cancer prognosis after curative colorectal resection, independently of anemia status (13). The potential mechanism, transfusion related immunomodulation (TRIM), act primary by reducing the cellular immune response, but also increases the production of growth factors that can promote tumor proliferation and metastasis (14,15).…”

Section: Introductionmentioning

confidence: 99%

Perioperative Anemia and Transfusion in Colorectal Cancer Patients

Ristescu¹,

Pintilie²,

Filip³

et al. 2019

chr

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RezumatIntroducere: Anemia şi transfuzia reprezintă factori de risc independenţi de evoluţie nefavorabilă în cancerul colorectal. Anemia severă poate creşte agresivitatea tumorală iar transfuzia poate induce imunosupresie, promovând astfel recurenţa cancerului. Strategiile de Gestionare a Sângelui Pacientului (GSP), specifice pentru pacienţii oncologici, sunt în prezent insuficient definite şi recomandate. Obiectiv primar: Evaluarea prevalenţei anemiei şi a ratei de transfuzie perioperator la pacienţii cu neoplasm colorectal. Obiectiv secundar: Analiză subgrup pacienţi anemici versus non-anemici, cancer de colon versus cancer rectal. Metodă: Am evaluat retrospectiv datele pacienţilor oncologici chirurgicali consecutivi admişi în intervalul Ianuarie-Iunie 2017. Am selectat pacienţii cu chirurgie abdominală inferioară şi ulterior chirurgie colo-rectală. Au fost înregistrate dinamica perioperatorie a valorilor hemoglobinei (preoperator = Hb1, postoperator = Hb2, la externare = Hb3), prevalenţa şi severitatea anemiei, rata de transfuzie. Analiza statistică a utilizat testele t Student, Wilcoxon şi Chi-pătrat din programul SPSS 17.0. Rezultate: Din 1284 pacienţi evaluaţi, 546 au fost supuşi chirurgiei abdominale inferioare şi 260 chirurgiei colorectale. Vârsta medie a fost de 65.6 ± 11.1 ani, 57.7% gen masculin. Dinamica perioperatorie a hemoglobinei a fost Hb1/Hb2/Hb3=12/10.6/10.4g/dl. Prevalenţa anemiei preoperator/ postoperator/ la externare a fost

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The Impact of Blood Transfusion on Recurrence and Mortality Following Colorectal Cancer Resection: A Propensity Score Analysis of 4,030 Patients

Cited by 97 publications

References 31 publications

Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer

Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer

The association of allogeneic blood transfusion and the recurrence of hepatic cancer after surgical resection

Perioperative Anemia and Transfusion in Colorectal Cancer Patients

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