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Blood transfusion does not adversely affect survival after elective colon cancer resection: a propensity score analysis

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Abstract

Purpose

The aim of this study was to assess the putative impact of perioperative blood transfusions on overall survival in patients undergoing curative resection for stage III colon cancer by applying propensity scoring methods.

Methods

In a single-center study, a total of 309 patients who underwent open curative resection for stages I–III colon cancer from 1996–2008 were assessed. The mean follow-up period was 47 ± 38 months. Transfused and non-transfused patients were compared using both Cox regression and propensity score analyses.

Results

Overall, 148 patients (47.9 %) received blood transfusions. The patient characteristics were highly biased toward transfusions (propensity score 0.68 ± 0.22 vs. 0.30 ± 0.22, p <0.001). In the unadjusted analysis, blood transfusions were associated with a 90 % increased risk of overall mortality (hazard ratio 1.90, 95 % CI: 1.19–3.04, p = 0.001). The 5-year survival for patients receiving blood transfusions was 64.5 % (95 % CI: 56.0–74.3 %) compared with 80.1 % (95 % CI: 72.8–88.2 %) in those not receiving blood transfusions. In the propensity score-adjusted Cox regression analysis (hazard ratio: 0.85, 95 % CI = 0.53–1.37, p = 0.501), blood transfusions did not increase the risk of overall mortality. After risk adjustment, the 5-year survival rate for patients receiving blood transfusions was 66.6 % (95 % CI: 57.4–77.3 %) compared with 61.8 % (95 % CI: 51.9–73.7 %) for those who did not.

Conclusion

This study is the first propensity score-based analysis that provides evidence that poor oncological outcomes after curative colon cancer resection in patients receiving perioperative blood transfusions are due to the clinical circumstances that require the transfusions and are not due to the blood transfusions.

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References

  1. Francis DM, Shenton BK (1981) Blood transfusion and tumour growth: evidence from laboratory animals. Lancet 318(8251):871

    Article  Google Scholar 

  2. Burrows L, Tartter P (1982) Effect of blood transfusions on colonic malignancy recurrent rate. Lancet 320(8299):662

    Article  Google Scholar 

  3. Amato A, Pescatori M (2006) Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev 1(CD005033)

  4. Benoist S, Panis Y, Pannegeon V, Alves A, Valleur P (2001) Predictive factors for perioperative blood transfusions in rectal resection for cancer: a multivariate analysis of a group of 212 patients. Surgery 129(4):433–439. doi:10.1067/msy.2001.112068

    PubMed  CAS  Google Scholar 

  5. Busch OR, Hop WC, Marquet RL, Jeekel J (1994) Blood transfusions and local tumor recurrence in colorectal cancer. Evidence of a noncausal relationship. Ann Surg 220(6):791–797

    Article  PubMed  CAS  Google Scholar 

  6. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  7. Govindarajulu US, Lin H, Lunetta KL, D’Agostino RB Sr (2011) Frailty models: applications to biomedical and genetic studies. Stat Med 30(22):2754–2764. doi:10.1002/sim.4277

    Article  PubMed  Google Scholar 

  8. Grambsch PM, Therneau TM (1994) Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81(3):515–526

    Article  Google Scholar 

  9. Schweizer Eidgenossenschaft Bundesamt für Statistik (2011) Jährliche Sterbetafeln. http://www.bfs.admin.ch/bfs/portal/de/index/themen/01/06/blank/dos/la_mortalite_en_suisse/tabl02.html. Accessed 12 July 2012

  10. Pohar M, Stare J (2007) Making relative survival analysis relatively easy. Comput Biol Med 37(12):1741–1749. doi:10.1016/j.compbiomed.2007.04.010

    Article  PubMed  Google Scholar 

  11. Andersen PK, Borch-Johnsen K, Deckert T, Green A, Hougaard P, Keiding N, Kreiner S (1985) A Cox regression model for the relative mortality and its application to diabetes mellitus survival data. Biometrics 41(4):921–932

    Article  PubMed  CAS  Google Scholar 

  12. Rosenbaum PR, Rubin DB (1985) Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat 39(1):33–38

    Google Scholar 

  13. Rubin DB (1997) Estimating causal effects from large data sets using propensity scores. Ann Intern Med 127(8 Pt 2):757–763

    Article  PubMed  CAS  Google Scholar 

  14. Hansen B, Klopfer SO (2006) Optimal full matching and related designs via network flows. J Comput Graph Stat 15(3):609–627

    Article  Google Scholar 

  15. Warschkow R, Güller U, Köberle D, Müller SA, Steffen T, Thurnheer M, Schmied BM, Tarantino I (2013) Peri-operative blood transfusions do not impact overall and disease-free survival after curative rectal cancer resection. A propensity score analysis. Ann Surg. doi:10.1097/SLA.0b013e318287ab4d

    PubMed  Google Scholar 

  16. Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26(2):303–312. doi:10.1200/JCO.2007.12.7027

    Article  PubMed  Google Scholar 

  17. Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, O’Callaghan C, Myint AS, Bessell E, Thompson LC, Parmar M, Stephens RJ, Sebag-Montefiore D, Investigators MCN-CCT, Group NCCS (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373(9666):821–828. doi:10.1016/S0140-6736(09)60485-2

    Article  PubMed  Google Scholar 

  18. Rodel C, Martus P, Papadoupolos T, Fuzesi L, Klimpfinger M, Fietkau R, Liersch T, Hohenberger W, Raab R, Sauer R, Wittekind C (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23(34):8688–8696. doi:10.1200/JCO.2005.02.1329

    Article  PubMed  Google Scholar 

  19. Busch OR, Hop WC, Hoynck van Papendrecht MA, Marquet RL, Jeekel J (1993) Blood transfusions and prognosis in colorectal cancer. N Engl J Med 328(19):1372–1376. doi:10.1056/NEJM199305133281902

    Article  PubMed  CAS  Google Scholar 

  20. Busch OR, Hop WC, Marquet RL, Jeekel J (1995) The effect of blood transfusions on survival after surgery for colorectal cancer. Eur J Cancer 31A(7–8):1226–1228

    Article  PubMed  CAS  Google Scholar 

  21. Harlaar JJ, Gosselink MP, Hop WC, Lange JF, Busch OR, Jeekel H (2012) Blood transfusions and prognosis in colorectal cancer: long-term results of a randomized controlled trial. Ann Surg 256(5):681–686. doi:10.1097/SLA.0b013e318271cedf

    Article  PubMed  Google Scholar 

  22. Acheson AG, Brookes MJ, Spahn DR (2012) Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg 256(2):235–244. doi:10.1097/SLA.0b013e31825b35d5

    Article  PubMed  Google Scholar 

  23. Leichtle SW, Mouawad NJ, Lampman R, Singal B, Cleary RK (2011) Does preoperative anemia adversely affect colon and rectal surgery outcomes? J Am Coll Surg 212(2):187–194. doi:10.1016/j.jamcollsurg.2010.09.013

    Article  PubMed  Google Scholar 

  24. Stramer SL (2007) Current risks of transfusion-transmitted agents: a review. Arch Pathol Lab Med 131(5):702–707. doi:10.1043/1543-2165(2007)131[702:CROTAA]2.0.CO;2

    PubMed  Google Scholar 

  25. Vamvakas EC, Blajchman MA (2007) Transfusion-related immunomodulation (TRIM): an update. Blood Rev 21(6):327–348. doi:10.1016/j.blre.2007.07.003

    Article  PubMed  Google Scholar 

  26. Heiss MM, Mempel W, Delanoff C, Jauch KW, Gabka C, Mempel M, Dieterich HJ, Eissner HJ, Schildberg FW (1994) Blood transfusion-modulated tumor recurrence: first results of a randomized study of autologous versus allogeneic blood transfusion in colorectal cancer surgery. J Clin Oncol 12(9):1859–1867

    PubMed  CAS  Google Scholar 

  27. Houbiers JG, Brand A, van de Watering LM, Hermans J, Verwey PJ, Bijnen AB, Pahlplatz P, Eeftinck Schattenkerk M, Wobbes T, de Vries JE et al (1994) Randomised controlled trial comparing transfusion of leucocyte-depleted or buffy-coat-depleted blood in surgery for colorectal cancer. Lancet 344(8922):573–578

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Ignazio Tarantino, Kristjan Ukegjini, Rene Warschkow, Bruno M. Schmied, Thomas Steffen & Sascha A. Müller

  2. Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany

    Rene Warschkow

  3. Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Alexis Ulrich

Authors
  1. Ignazio Tarantino
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  2. Kristjan Ukegjini
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  3. Rene Warschkow
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  4. Bruno M. Schmied
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  5. Thomas Steffen
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  6. Alexis Ulrich
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  7. Sascha A. Müller
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Correspondence to Ignazio Tarantino.

Additional information

Ignazio Tarantino and Kristjan Ukegjini contributed equally to this work.

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Tarantino, I., Ukegjini, K., Warschkow, R. et al. Blood transfusion does not adversely affect survival after elective colon cancer resection: a propensity score analysis. Langenbecks Arch Surg 398, 841–849 (2013). https://doi.org/10.1007/s00423-013-1098-x

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  • DOI: https://doi.org/10.1007/s00423-013-1098-x

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