Perioperative blood transfusions are associated with decreased time to recurrence and decreased survival after resection of colorectal liver metastases (original) (raw)

Abstract

Data from fifty-five patients who had hepatic resections for colorectal liver metastases at the National Cancer Institute (NCI) were analyzed to determine the effect of perioperative blood transfusions on disease recurrence and overall survival. Besides blood transfusions, other factors included in the analysis were size, number, and distribution of metastases, margin status of resected metastases, length of disease-free interval, Duke's stage of the primary tumor, type of hepatic resection, and anesthesia time. Using the Cox proportional hazards model, the amount of blood transfused was found to be a significant prognostic factor. For each additional unit of blood transfused the risk of disease recurrence and death was increased by 5% (p = 0.0015) and 7% (p = 0.0013), respectively. The median disease-free survival for patients who received 3-5, 6-10, and greater than or equal to 11 transfused units was 26, 12.1, and 11.4 months, respectively. The median overall survival for patients who received 3-5, 6-10, and greater than or equal to 11 transfused units was greater than 44, 39.2, and 33.6 months, respectively. The number of resected nodules (1-2 vs. greater than or equal to 3), type of resection (anatomic lobectomy vs. wedge resection), and nodule size (less than or equal to 3.0 cm vs. greater than 3.0 cm) were additional factors that were further evaluated to determine the effect of blood transfusions. Analyses stratified for each of these factors revealed that patients who received greater than or equal to 11 units of blood had a significantly decreased disease-free and overall survival compared with patients who received 3-10 units of blood. It is concluded that the amount of perioperative blood transfused is an independent prognostic factor that adversely effects disease-free and overall survival.

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Selected References

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  1. Blumberg N., Agarwal M. M., Chuang C. Relation between recurrence of cancer of the colon and blood transfusion. Br Med J (Clin Res Ed) 1985 Apr 6;290(6474):1037–1039. doi: 10.1136/bmj.290.6474.1037. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Blumberg N., Heal J. M., Murphy P., Agarwal M. M., Chuang C. Association between transfusion of whole blood and recurrence of cancer. Br Med J (Clin Res Ed) 1986 Aug 30;293(6546):530–533. doi: 10.1136/bmj.293.6546.530. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Burrows L., Tartter P., Aufses A. Increased recurrence rates in perioperatively transfused colorectal malignancy patients. Cancer Detect Prev. 1987;10(5-6):361–369. [PubMed] [Google Scholar]
  4. Creasy T. S., Veitch P. S., Bell P. R. A relationship between perioperative blood transfusion and recurrence of carcinoma of the sigmoid colon following potentially curative surgery. Ann R Coll Surg Engl. 1987 May;69(3):100–103. [PMC free article] [PubMed] [Google Scholar]
  5. Fischer E., Lenhard V., Seifert P., Kluge A., Johannsen R. Blood transfusion-induced suppression of cellular immunity in man. Hum Immunol. 1980 Oct;1(3):187–194. doi: 10.1016/0198-8859(80)90013-0. [DOI] [PubMed] [Google Scholar]
  6. Foster R. S., Jr, Costanza M. C., Foster J. C., Wanner M. C., Foster C. B. Adverse relationship between blood transfusions and survival after colectomy for colon cancer. Cancer. 1985 Mar 15;55(6):1195–1201. doi: 10.1002/1097-0142(19850315)55:6<1195::aid-cncr2820550610>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  7. Foster R. S., Jr, Foster J. C., Costanza M. C. Blood transfusions and survival after surgery for breast cancer. Arch Surg. 1984 Oct;119(10):1138–1140. doi: 10.1001/archsurg.1984.01390220024005. [DOI] [PubMed] [Google Scholar]
  8. Francis D. M., Burren C. P., Clunie G. J. Acceleration of B16 melanoma growth in mice after blood transfusion. Surgery. 1987 Sep;102(3):485–492. [PubMed] [Google Scholar]
  9. Francis D. M., Judson R. T. Blood transfusion and recurrence of cancer of the colon and rectum. Br J Surg. 1987 Jan;74(1):26–30. doi: 10.1002/bjs.1800740110. [DOI] [PubMed] [Google Scholar]
  10. Francis D. M., Shenton B. K. Blood transfusion and tumour growth: evidence from laboratory animals. Lancet. 1981 Oct 17;2(8251):871–871. doi: 10.1016/s0140-6736(81)91133-8. [DOI] [PubMed] [Google Scholar]
  11. Frankish P. D., McNee R. K., Alley P. G., Woodfield D. G. Relation between cancer of the colon and blood transfusion. Br Med J (Clin Res Ed) 1985 Jun 15;290(6484):1827–1827. doi: 10.1136/bmj.290.6484.1827-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Gascón P., Zoumbos N. C., Young N. S. Immunologic abnormalities in patients receiving multiple blood transfusions. Ann Intern Med. 1984 Feb;100(2):173–177. doi: 10.7326/0003-4819-100-2-173. [DOI] [PubMed] [Google Scholar]
  13. Horimi T., Kagawa S., Ninomiya M., Yoshida E., Hiramatsu S., Orita K. Possible induction by blood transfusion of immunological tolerance against growth of transplanted tumors in mice. Acta Med Okayama. 1983 Jun;37(3):259–263. doi: 10.18926/AMO/32434. [DOI] [PubMed] [Google Scholar]
  14. Hunsicker L. G., Oei L. S., Freeman R. M., Thompson J. S., Corry R. J. Effect of blood transfusions on cadaver renal allograft survival. Transplant Proc. 1979 Mar;11(1):156–159. [PubMed] [Google Scholar]
  15. Hyman N. H., Foster R. S., Jr, DeMeules J. E., Costanza M. C. Blood transfusions and survival after lung cancer resection. Am J Surg. 1985 Apr;149(4):502–507. doi: 10.1016/s0002-9610(85)80047-7. [DOI] [PubMed] [Google Scholar]
  16. Jacobson M. S., Kevy S. V., Grand R. J. Effects of a plasticizer leached from polyvinyl chloride on the subhuman primate: a consequence of chronic transfusion therapy. J Lab Clin Med. 1977 May;89(5):1066–1079. [PubMed] [Google Scholar]
  17. Kagawa S. [Enhancement by blood transfusions of transplanted tumor growth in mice]. Nihon Geka Gakkai Zasshi. 1984 Jun;85(6):513–520. [PubMed] [Google Scholar]
  18. Kaneda M., Horimi T., Ninomiya M., Nagae S., Mukai K., Takeda I., Shimoyama H., Chohno S., Okabayashi T., Kagawa S. Adverse affect of blood transfusions on survival of patients with gastric cancer. Transfusion. 1987 Sep-Oct;27(5):375–377. doi: 10.1046/j.1537-2995.1987.27587320526.x. [DOI] [PubMed] [Google Scholar]
  19. Lundy J., Lovett E. J., 3rd, Hamilton S., Conran P. Halothane, surgery, immunosuppression and artificial pulmonary metastases. Cancer. 1978 Mar;41(3):827–830. doi: 10.1002/1097-0142(197803)41:3<827::aid-cncr2820410307>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  20. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966 Mar;50(3):163–170. [PubMed] [Google Scholar]
  21. Nathanson S. D., Tilley B. C., Schultz L., Smith R. F. Perioperative allogeneic blood transfusions. Survival in patients with resected carcinomas of the colon and rectum. Arch Surg. 1985 Jun;120(6):734–738. doi: 10.1001/archsurg.1985.01390300076013. [DOI] [PubMed] [Google Scholar]
  22. Oikawa T., Hosokawa M., Imamura M., Sendo F., Nakayama M. Anti-tumour immunity by normal allogeneic blood transfusion in rat. Clin Exp Immunol. 1977 Mar;27(3):549–554. [PMC free article] [PubMed] [Google Scholar]
  23. Okazaki H., Maki T., Wood M. L., Jones S., Monaco A. P. Prolongation of skin allograft survival in H-2 K and I region-incompatible mice by pretransplant blood transfusion. Transplantation. 1981 Aug;32(2):111–115. doi: 10.1097/00007890-198108000-00006. [DOI] [PubMed] [Google Scholar]
  24. Opelz G., Graver B., Terasaki P. I. Induction of high kidney graft survival rate by multiple transfusion. Lancet. 1981 Jun 6;1(8232):1223–1225. doi: 10.1016/s0140-6736(81)92398-9. [DOI] [PubMed] [Google Scholar]
  25. Opelz G., Lenhard V. Immunological factors influencing renal graft survival. Annu Rev Med. 1983;34:133–144. doi: 10.1146/annurev.me.34.020183.001025. [DOI] [PubMed] [Google Scholar]
  26. Opelz G., Sengar D. P., Mickey M. R., Terasaki P. I. Effect of blood transfusions on subsequent kidney transplants. Transplant Proc. 1973 Mar;5(1):253–259. [PubMed] [Google Scholar]
  27. Opelz G., Terasaki P. I. Dominant effect of transfusions on kidney graft survival. Transplantation. 1980 Feb;29(2):153–158. doi: 10.1097/00007890-198002000-00013. [DOI] [PubMed] [Google Scholar]
  28. Ota D., Alvarez L., Lichtiger B., Giacco G., Guinee V. Perioperative blood transfusion in patients with colon carcinoma. Transfusion. 1985 Jul-Aug;25(4):392–394. doi: 10.1046/j.1537-2995.1985.25485273825.x. [DOI] [PubMed] [Google Scholar]
  29. Parrott N. R., Lennard T. W., Taylor R. M., Proud G., Shenton B. K., Johnston I. D. Effect of perioperative blood transfusion on recurrence of colorectal cancer. Br J Surg. 1986 Dec;73(12):970–973. doi: 10.1002/bjs.1800731208. [DOI] [PubMed] [Google Scholar]
  30. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Registry of Hepatic Metastases. Surgery. 1988 Mar;103(3):278–288. [PMC free article] [PubMed] [Google Scholar]
  31. Rosenberg S. A., Seipp C. A., White D. E., Wesley R. Perioperative blood transfusions are associated with increased rates of recurrence and decreased survival in patients with high-grade soft-tissue sarcomas of the extremities. J Clin Oncol. 1985 May;3(5):698–709. doi: 10.1200/JCO.1985.3.5.698. [DOI] [PubMed] [Google Scholar]
  32. Sanfilippo F., Spees E. K., Vaughn W. K. The timing of pretransplant transfusions and renal allograft survival. Transplantation. 1984 Apr;37(4):344–350. doi: 10.1097/00007890-198404000-00005. [DOI] [PubMed] [Google Scholar]
  33. Tarpley J. L., Twomey P. L., Catalona W. J., Chretien P. B. Suppression of cellular immunity by anesthesia and operation. J Surg Res. 1977 Mar;22(3):195–201. doi: 10.1016/0022-4804(77)90134-2. [DOI] [PubMed] [Google Scholar]
  34. Tartter P. I., Burrows L., Kirschner P. Perioperative blood transfusion adversely affects prognosis after resection of Stage I (subset N0) non-oat cell lung cancer. J Thorac Cardiovasc Surg. 1984 Nov;88(5 Pt 1):659–662. [PubMed] [Google Scholar]
  35. Tartter P. I., Burrows L., Papatestas A. E., Lesnick G., Aufses A. H., Jr Perioperative blood transfusion has prognostic significance for breast cancer. Surgery. 1985 Feb;97(2):225–230. [PubMed] [Google Scholar]
  36. Terasaki P. I. The beneficial transfusion effect on kidney graft survival attributed to clonal deletion. Transplantation. 1984 Feb;37(2):119–125. doi: 10.1097/00007890-198402000-00001. [DOI] [PubMed] [Google Scholar]
  37. Wang B. S., Heacock E. H., Mannick J. A. Characterization of suppressor cells generated in mice after surgical trauma. Clin Immunol Immunopathol. 1982 Aug;24(2):161–170. doi: 10.1016/0090-1229(82)90227-6. [DOI] [PubMed] [Google Scholar]
  38. Ward J. M., Rice J. M., Creasia D., Lynch P., Riggs C. Dissimilar patterns of promotion by di(2-ethylhexyl)phthalate and phenobarbital of hepatocellular neoplasia initiated by diethylnitrosamine in B6C3F1 mice. Carcinogenesis. 1983 Aug;4(8):1021–1029. doi: 10.1093/carcin/4.8.1021. [DOI] [PubMed] [Google Scholar]
  39. Warren J. R., Lalwani N. D., Reddy J. K. Phthalate esters as peroxisome proliferator carcinogens. Environ Health Perspect. 1982 Nov;45:35–40. doi: 10.1289/ehp.824535. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Waymack J. P., Warden G. D., Alexander J. W., Miskell P., Gonce S. Effect of blood transfusion and anesthesia on resistance to bacterial peritonitis. J Surg Res. 1987 May;42(5):528–535. doi: 10.1016/0022-4804(87)90028-x. [DOI] [PubMed] [Google Scholar]
  41. Weiden P. L., Bean M. A., Schultz P. Perioperative blood transfusion does not increase the risk of colorectal cancer recurrence. Cancer. 1987 Aug 15;60(4):870–874. doi: 10.1002/1097-0142(19870815)60:4<870::aid-cncr2820600425>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
  42. Williams K. A., Ting A., French M. E., Oliver D., Morris P. J. Peroperative blood-transfusion improve cadaveric renal-allograft survival in non-transfused recipients. A prospective controlled clinical trial. Lancet. 1980 May 24;1(8178):1104–1106. doi: 10.1016/s0140-6736(80)91553-6. [DOI] [PubMed] [Google Scholar]
  43. Wood M. L., Gottschalk R., Monaco A. P. Comparison of immune responsiveness in mice after single or multiple donor-specific transfusions. J Immunol. 1984 Feb;132(2):651–655. [PubMed] [Google Scholar]
  44. van Es A. A., Balner H. Effect of pretransplant transfusions on kidney allograft survival. Transplant Proc. 1979 Mar;11(1):127–137. [PubMed] [Google Scholar]