The impact of perioperative allogeneic blood transfusion on prognosis of hepatocellular carcinoma after radical hepatectomy

Xun, Yangqin; Tian, Hongwei; Hu, Lin; Yan, Peijing; Yang, Kehu; Guo, Tiankang

doi:10.1097/md.0000000000012911

Cited by 35 publications

(35 citation statements)

References 40 publications

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“…Secondly, perioperative blood transfusions were independently associated with survival and cancer recurrence after surgical resection ( 36 ). A meta-analysis found that allogeneic blood transfusions were associated with poor clinical prognoses in patients with HCC who underwent radical hepatectomy ( 37 ). The association between major resection and blood loss as well as RFS of HCC patients has been examined: the more complicated hepatectomy is, the more likely patients are to suffer from intraoperative blood loss, leading to shorter time to recurrence ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Machine Learning Prognostic Model for Hepatocellular Carcinoma Recurrence After Surgical Resection

et al. 2021

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Surgical resection remains primary curative treatment for patients with hepatocellular carcinoma (HCC) while over 50% of patients experience recurrence, which calls for individualized recurrence prediction and early surveillance. This study aimed to develop a machine learning prognostic model to identify high-risk patients after surgical resection and to review importance of variables in different time intervals. The patients in this study were from two centers including Eastern Hepatobiliary Surgery Hospital (EHSH) and Mengchao Hepatobiliary Hospital (MHH). The best-performed model was determined, validated, and applied to each time interval (0–1 year, 1–2 years, 2–3 years, and 3–5 years). Importance scores were used to illustrate feature importance in different time intervals. In addition, a risk heat map was constructed which visually depicted the risk of recurrence in different years. A total of 7,919 patients from two centers were included, of which 3,359 and 230 patients experienced recurrence, metastasis or died during the follow-up time in the EHSH and MHH datasets, respectively. The XGBoost model achieved the best discrimination with a c-index of 0.713 in internal validation cohort. Kaplan-Meier curves succeed to stratify external validation cohort into different risk groups (p < 0.05 in all comparisons). Tumor characteristics contribute more to HCC relapse in 0 to 1 year while HBV infection and smoking affect patients’ outcome largely in 3 to 5 years. Based on machine learning prediction model, the peak of recurrence can be predicted for individual HCC patients. Therefore, clinicians can apply it to personalize the management of postoperative survival.

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Section: Discussionmentioning

confidence: 99%

Development and Validation of a Machine Learning Prognostic Model for Hepatocellular Carcinoma Recurrence After Surgical Resection

et al. 2021

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“…The median duration of the PM in the present study was less than 20 minutes. Conversely, blood loss during hepatectomy and subsequent perioperative blood transfusion has been associated with poor overall and disease-free survival in hepatocellular carcinoma patients 35,40 . Therefore, not only does a shorter PM not increase the recurrence rate but it may even reduce it by preventing excessive blood loss and need for a blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

Pringle Maneuver in Extended Liver Resection: A propensity score analysis

Al-Saeedi

Ghamarnejad

Khajeh

et al. 2020

Sci Rep

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Despite the ongoing decades-long controversy, pringle maneuver (pM) is still frequently used by hepatobiliary surgeons during hepatectomy. The aim of this study was to investigate the effect of PM on intraoperative blood loss, morbidity, and posthepatectomy hemorrhage (PHH). A series of 209 consecutive patients underwent extended hepatectomy (eH) (≥5 segment resection). The association of pM with perioperative outcomes was evaluated using multivariate analysis with a propensity score method to control for confounding. Fifty patients underwent PM with a median duration of 19 minutes. Multivariate analysis revealed that risk of excessive intraoperative bleeding (≥1500 ml; odds ratio [OR] 0.27, 95%-confidence interval [CI] 0.10-0.70, p = 0.007), major morbidity (OR 0.41, 95%-CI 0.18-0.97, p = 0.041), and PHH (OR 0.22, 95%-CI 0.06-0.79, p = 0.021) were significantly lower in PM group after EH. Furthermore, there was no significant difference in 3-year recurrence-free-survival between groups. pM is associated with lower intraoperative bleeding, pHH, and major morbidity risk after eH. Performing PM does not increase posthepatectomy liver failure and does not affect recurrence rate. Therefore, PM seems to be justified in EH. Extended hepatectomy (EH) is the only curative treatment option for patients with large primary or bilobar metastatic liver malignancies 1. Better patient selection and developments in surgical techniques and instruments have increased the number and safety of EH 2,3. However, the risk of complications such as intraoperative bleeding, especially in patients with large tumors or tumors near to major vessels, is still high. These factors are associated with poorer postoperative outcomes 4,5. Patients with massive intraoperative blood loss have a higher rate of posthepatectomy morbidity and mortality 2 and lower recurrence-free survival due to blood transfusion 6. Therefore, reducing intraoperative bleeding during EH and reducing the amount of blood products transfused are important points in liver surgery. Despite the ongoing controversy regarding the advantages and disadvantages of hepatic inflow control during hepatectomy, the Pringle maneuver (PM) remains the most commonly used and evidence-based method of hepatic inflow control 7. The PM significantly decreases intraoperative blood loss, the amount of blood products transfused, and operation time, especially when performed in combination with low central venous pressure 8-10. Nevertheless, there is no evidence that the PM can reduce posthepatectomy morbidity and mortality 11,12 ; in fact, the PM may result in ischemia-reperfusion injury of the liver, which negatively affects hepatocyte metabolism, thereby increasing the rate of posthepatectomy liver failure (PHLF) 13,14. Despite several studies investigating the role of the PM in liver resection, the effects of the PM on intra-and postoperative outcomes have not been investigated exclusively in EH, which has a higher risk of intraoperative bleeding than minor hepatectomies 15. In addition, applica...

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“…Other than these factors, several clinical factors have also been suggested in association with cancer prognosis [18,19]. Among these, blood transfusion using allogeneic pRBC units has been extensively examined in various types of cancer, and these studies have suggested a deleterious effect on prognosis [3][4][5][6][7]. In addition to the combined impact of surgery and anesthesia-induced immunosuppression, administration of blood products can further aggravate the immunosuppressive status of cancer patients, resulting in transfusion-related immune modulation (TRIM).…”

Section: Discussionmentioning

confidence: 99%

“…In particular, curative surgery for malignancy is always associated with the risk for massive bleeding; therefore, the probability of blood transfusion may also increase. However, the results of several meta-analyses have consistently indicated the existence of a negative association between perioperative blood transfusion (PBT) and oncologic outcomes, including tumor recurrence and survival, in surgically treated patients with various malignancies, including stomach, lung, liver, and colorectal cancer [3][4][5][6][7]. Although the mechanism underlying this unfavorable association is not fully understood, it is hypothesized that immune modulation and inflammatory responses caused by PBT adversely affect oncologic outcomes after radical surgery for cancer [1,2,8].…”

Section: Introductionmentioning

confidence: 99%

Impact of perioperative blood transfusion on oncologic outcomes in patients with nonmetastatic renal cell carcinoma treated with curative nephrectomy: A retrospective analysis of a large, single-institutional cohort

et al. 2020

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Purpose: To evaluate the impact of perioperative blood transfusion (PBT) on oncologic outcomes after surgery in patients with nonmetastatic renal cell carcinoma (RCC). Materials and Methods: This retrospective review included 2,329 patients who underwent partial or radical nephrectomy for localized RCC in a single institution from 2000 to 2014. PBT was defined as transfusion of allogeneic packed red blood cells (pRBCs) during nephrectomy or within the preoperative or postoperative hospitalization period. Oncologic outcomes of interest were recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS). Results: PBT was performed in 275 patients (11.8%). In the multivariable logistic regression analysis, symptomatic presentation, advanced age at surgery, higher preoperative serum creatinine, and lower preoperative hemoglobin were independent preoperative risk factors for PBT (all p<0.05). Kaplan-Meier plots revealed that transfused patients showed poorer 5-year RFS (65.1% vs. 91.2%, p<0.001), OS (71.4% vs. 92.8%, p<0.001), and CSS (74.0% vs. 95.5%, p<0.001) than nontransfused patients. However, in the multivariable Cox regression analyses, PBT was not significantly associated with RFS, OS, or CSS. In multivariable analyses involving transfused patients only (n=275), an higher number of pRBC units was an independent predictor of worse OS (hazard ratio [HR], 1.043; 95% confidence interval [CI], 1.008-1.078; p=0.016) and CSS (HR, 1.066; 95% CI, 1.033-1.100; p<0.001). Conclusions: The results of this study are inconclusive in that the influence of PBT on survival outcomes could not be determined in the multivariate analysis. However, increasing pRBC units in transfused patients might be a concern in light of worse OS and CSS. Therefore, efforts to limit PBT overuse seem necessary to improve postoperative survival in patients with RCC.

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The impact of perioperative allogeneic blood transfusion on prognosis of hepatocellular carcinoma after radical hepatectomy

Abstract: Supplemental Digital Content is available in the text

Cited by 35 publications

References 40 publications

Development and Validation of a Machine Learning Prognostic Model for Hepatocellular Carcinoma Recurrence After Surgical Resection

Development and Validation of a Machine Learning Prognostic Model for Hepatocellular Carcinoma Recurrence After Surgical Resection

Pringle Maneuver in Extended Liver Resection: A propensity score analysis

Impact of perioperative blood transfusion on oncologic outcomes in patients with nonmetastatic renal cell carcinoma treated with curative nephrectomy: A retrospective analysis of a large, single-institutional cohort

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