Does transfusion modify the outcome of cancer resections?

[Use of blood products in patients treated surgically for stage I non-small cell lung cancer]

OBJECTIVE

Retrospective study on the relation between the use of blood products and survival rates in patients treated surgically for stage I non-small cell lung cancer (NSCLC).

PATIENTS AND METHODS

The study included 856 patients who underwent surgical resection from 1969 to 2000 for stage I NSCLC, classified histologically according to the current guidelines of the Spanish Society of Pulmonary and Thoracic Surgery (SEPAR). Patients who died in the postoperative period were excluded from the study. A series of clinicopathological variables were recorded, including the perioperative use or not of blood products. Descriptive, univariate, and multivariate statistical analyses were performed. Follow up concluded in December of 2003.

RESULTS

One hundred twenty-five patients (14.6%) underwent a perioperative transfusion. A significant association was found between the use of blood products and tumor size (P<.001), pneumectomy (P<.001), and cell type (P<.05). The respective 2, 5, and 10-year survival rates were 78%, 63%, and 54% for the nontransfusion group, and 73%, 59%, and 46% for the transfusion group. Both survival curves were compared and no significant differences were found (P=.23). Multivariate regression analysis included tumor size, patient age, and histologic cell type (squamous cell carcinoma or not); no relation between transfusion and survival was found.

CONCLUSIONS

In our series, we found no difference in survival rates for patients with stage I NSCLC after perioperative blood transfusion.

Ten-year survival after resection for lung carcinoma. Effect of blood transfusion and tumour stage on outcome

The objectives were to evaluate the prognosis in resected lung cancer and to observe if perioperative blood transfusion adversely affects the prognosis. Of 208 patients with resection for lung cancer in 1978-1980, all but five were smokers: 127 had squamous cell and 81 non-squamous cell carcinoma. Stage I disease was found in 143 patients. (69%), stage II in 18 (9%) and stage IIIa in 47 (23%). Five-year survival was 52% in stage I, 29% in stage II and 7% in stage IIIa tumour; the respective 10-year rates were 37, 19 and 3%. Patients given perioperative blood transfusion (n = 95) had poorer prognosis than the non-transfused patients. According to Cox multivariate analysis, however, the relative risk of death was only slightly increased by perioperative transfusion (p = 0.07). In patients with stage II or IIIa carcinoma at diagnosis, this relative risk was 2.17 and 4.99 times higher than in stage I (p = 0.004 and p = 0.0001). Long-term survival thus was related to extent of the disease at diagnosis rather than to numbers of blood transfusions.

The adverse effect of perioperative blood transfusion in lung cancer

Perioperative blood transfusion appears to increase the risk of recurrence and death in patients with surgically resected lung cancer. This finding is consistent with that in other cancers and several studies in lung cancer report similar risk elevations. We have reanalyzed the Lung Cancer Study Group data relevant to this question, assessing the potential confounding effects of some prognostic factors not examined previously. The results are nearly identical to those reported earlier, suggesting that increased risk is attributable to blood transfusion and not to confounding by known prognostic factors.

Significance of perioperative blood transfusions in patients undergoing resection of stage I and II non-small-cell lung cancers

Perioperative blood transfusions (BT) have been reported to reduce survival in patients undergoing curative resection of lung cancers. It is postulated that a state of BT-mediated immunosuppression favors the proliferation of tumor cells not resected during surgery. To evaluate this hypothesis and to determine factors influencing the administration of BT, we retrospectively studied the charts of 127 patients who underwent surgery for stage I and II non-small-cell carcinoma. Thirty (23.6 percent) patients received BT and 97 (76.4 percent) did not. Sex, age, race, smoking history, size and stage of the tumor, histology, extent of resection and preoperative hemoglobin values were analyzed. Only age (p = 0.01) and preoperative hemoglobin values (p less than 0.01) were related to transfusion status. Neither survival nor event-free survival differed significantly between the two groups (p = 0.29 and 0.26 respectively). Our results do not support the hypothesis that perioperative BTs have a significant detrimental effect on survival. A prospective study could clarify this controversial issue; however, such a study would be complex considering the multiple variables that affect survival in patients with non-small-cell lung cancers.