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The effects of blood transfusion on the prognosis of patients with gastric cancer

World Journal of Surgery volume 13, pages 637–643 (1989)Cite this article

Abstract

The effect of perioperative blood transfusion on the survival rate of patients with gastric cancer was studied. One thousand patients with primary gastric cancer, who had curative surgery performed at the National Cancer Center Hospital in Japan from 1976 to 1981, were studied retrospectively. Overall comparison of transfused (n=371) versus nontransfused (n=629) patients by log rank analysis revealed a statistically significant adverse influence of blood transfusion on survival (p=0.0001). Fifty-seven percent of transfused as compared to 80.8% of nontransfused patients survived for 5 years or more; however, after stratifying patients into stages and applying proportional regression analyses, blood transfusion did not appear to have any effect on prognosis: relative risk ratio, 1.16;p=0.28. Similarly, comparison of patients transfused with more than 600 cc of blood and those transfused with 600 cc of blood or less revealed no statistical difference in survival time.

It is postulated that the possible adverse influence of blood transfusion on the survival of patients with gastric cancer is linked to other prognostic features rather than to the immunologic sequelae of the transfusion itself.

Résumé

L'effet des transfusions sanguines periopératoires sur la survie des patients ayant un cancer gastrique a été étudié. Mille patients ayant un cancer primitif de l'estomac, ayant subi une résection à visée curative entre 1976 et 1981 au Centre Hospitalier National du Cancer au Japon ont été étudiés rétrospectivement. L'analyse selon la méthode du log rank a montré que la survie des patients ayant eu des transfusions (n=371) était nettement moins bonne que celle des patients qui n'en avaient pas reçues (n=629) (p=0.0001). Parmi les patients ayant reçu des transfusions, la survie à 5 ans était de 57% comparé a 80.8% quand les patients n'en avaient pas reçu (p=0.0001). Après stratification et en appliquant une analyse de régression proportionnelle, la transfusion sanguine ne paraît pas influencer le pronostic. Le rapport de risque relatif était de 1.16 avecp= 0.28. De même, la survie entre les patients ayant eu plus ou moins de 600 ml de sang en transfusion ne différait pas.

On postule que les effets nocifs éventuels des transfusions sur la survie des patients ayant un cancer gastrique sont liés à des facteurs pronostiques autres que la conséquence immunologique des transfusions en elles-mêmes.

Resumen

Se estudió el efecto de la transfusión perioperatoria de sangre sobre la tasa de supervivencia en pacientes con cáncer gástrico. Mil pacientes con cáncer gástrico primario que recibieron cirugía curativa en el Hospital Centra Nacional de Cáncer de Japón entre 1976 y 1981 fueron estudiados en forma retrospectiva. La comparación global de los pacientes transfundidos (n= 371) versus los no transfundidos (n=629) reveló una influencia significativamente adversa de la transfusión sanguínea sobre la supervivencia (p=0.0001). Cincuenta y siete por ciento de los pacientes transfundidos y 80.8% de los no transfundidos sobrevivieron 5 años o más; sin embargo, después de estratificar los pacientes según estadio y aplicando análisis proporcional de regresión, la transfusión sanguínea no pareció tener efecto alguno sobre el pronóstico: relación de riesgo relativo, 1.16;p= 0.28. Así mismo, la comparación de los pacientes transfundidos con más de 600 cc de sangre y de los transfundidos con 600 cc o menos de 600 cc no reveló una diferencia estadística en el tiempo de sobrevida.

La conclusión es que la administración de sangre homóloga parece no tener influencia sobre la supervivencia a 5 años de pacientes sometidos a cirugía curativa para carcinoma gástrico.

Se postula que el posible efecto adverso de la transfusión sanguínea sobre la sobrevida de pacientes con cáncer gástrico está ligada a otros factores de pronóstico más que a las secuelas inmunológicas de la transfusión misma.

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References

  1. Burrows, L., Tartter, P.: Effect of blood transfusion on colonic malignancy recurrence rate. Lancet2:662, 1982

    Google Scholar 

  2. Francis, D.M.A., Judson, R.: Relation between recurrence of cancer of the colon and blood transfusion. Br. Med. J.291:544, 1985

    Google Scholar 

  3. Nathanson, S.D., Tilley, B., Schultz, L., Smith, R.F.: Perioperative allogenic blood transfusions. Arch. Surg.120:734, 1985

    Google Scholar 

  4. Ota, D., Alvarez, L., Lichtiger, B., Giacco, G., Guinee, V.: Perioperative blood transfusion in patients with colon carcinoma. Transfusion25:392, 1985

    Google Scholar 

  5. Blair, S.D., Jarvin, S.B.: Relation between cancer of the colon and blood transfusion. Br. Med. J.290:1516, 1985

    Google Scholar 

  6. Blumberg, N., Agarwal, M.M., Chuang, C.: Relation between recurrence of cancer of the colon and blood transfusion. Br. Med. J.290:1037, 1985

    Google Scholar 

  7. Burrows, L., Tartter, P., Aufses, A.: Increased recurrence rates in perioperatively transfused colorectal malignancy patients. Cancer Detect. Prev.10:361, 1987

    Google Scholar 

  8. Corman, J., Arnoux, R., Péloquin, A., St. Louis, G., Smeester, C., Giroux, L.: Blood transfusion and survival after colectomy for colorectal cancer. Can. J. Surg.29:325, 1986

    Google Scholar 

  9. Foster, R.S., Costanza, M.C., Foster, J.C., Wanner, M.C., Foster, C.B.: Adverse relationship between blood transfusion and survival after colectomy for colon cancer. Cancer55:1195, 1985

    Google Scholar 

  10. Parrott, N.R., Lennard, T.W.J., Taylor, R.M.R., Proud, R., Shenton, B.K., Johnston, I.D.A.: Effect of perioperative blood transfusion on recurrence of colorectal cancer. Br. J. Surg.73:970, 1986

    Google Scholar 

  11. Voogt, P.J., van de Velde, C.J.H., Brand, A., Hermans, J., Stijnen, T., Bloem, R., Leer, J.W.H., Zwaveling, A., van Rood, J.J.: Perioperative blood transfusion and cancer prognosis—Different effects of blood transfusion on prognosis of colon and breast cancer patients. Cancer59:836, 1987

    Google Scholar 

  12. Fielding, L.P.: Red for danger: Blood transfusion and colorectal cancer. Br. Med. J.291:841, 1985

    Google Scholar 

  13. Frankish, P.O., McNee, R.K., Alley, P.G., Woodfield, D.G.: Relation between cancer of the colon and blood transfusion. Br. Med. J.290:1827, 1985

    Google Scholar 

  14. Hamblin, T.J.: Blood transfusion and cancer: Anomalies explained? Br. Med. J.293:517, 1986

    Google Scholar 

  15. Lavies, N.G., Long, T., Hoffler, D.E.: Blood transfusion and colorectal cancer. Br. Med. J.291:1279, 1985

    Google Scholar 

  16. Francis, D.M.A.: Blood transfusions and colorectal cancer. Br. J. Anaesthesia60:120, 1988

    Google Scholar 

  17. Kaneda, M., Hiromi, M., Nimomiya, M., Nagae, S., Mukai, K., Takeda, I., Shimoyama, H., Chohno, S., Okabayashi, T., Kagawa, S., Orita, K.: Adverse effect of blood transfusion on survival of patients with gastric cancer. Transfusion27:375, 1987

    Google Scholar 

  18. Schriemer, P.A., Longecker, D.E., Mintz, P.D.: The possible immunosuppressive effects of perioperative blood transfusion in cancer patients. Anesthesiology68:422, 1988

    Google Scholar 

  19. Tsujitani, S.: Langerhans cells and prognosis in patients with gastric carcinoma. Cancer59:501, 1987

    Google Scholar 

  20. Maruyama, K.: The most important prognostic factors for gastric cancer patients. Scand. J. Gastroenterol.22(Suppl. 133):63, 1987

    Google Scholar 

  21. Cox, D.R.: Regression models and life tables. J.R. Stat. Soc. SerB.34:187, 1972

    Google Scholar 

  22. Harrell, F.E.: The PHGLM Procedure. Gugi Supplemental Library User's Guide, fifth edition, Cary, NC, SAS Institute, Inc., 1987, pp. 438–466

    Google Scholar 

  23. Burnet, M.: Somatic mutation and chronic disease. Br. Med. J.1:338, 1965

    Google Scholar 

  24. Gatti, R.A., Good, R.A.: Occurrence of malignancy in immunodeficiency disease. Cancer28:89, 1971

    Google Scholar 

  25. Kinlen, L.J., Sheil, A.G.R., Peto, J., Doll, R.: Collaborative United Kingdom-Australian study of cancer in patients treated with immunosuppressive drugs. Br. Med. J.2:1461, 1979

    Google Scholar 

  26. Opelz, G., Terasaki, P.I.: Poor kidney transplant survival in recipients with frozen blood transfusions or no transfusions. Lancet2:696, 1974

    Google Scholar 

  27. George, C.D., Morello, P.J.: The immunological effects of blood transfusion on renal transplants, tumor operations and bacterial infections. Am. J. Surg.152:329, 1986

    Google Scholar 

  28. Kerman, R.H., van Buren, C.T., Flechner, S., Agostino, G., Conley, S., Brewer, E., Kahan, B.D.: Influence of blood transfusions on immune responsiveness. Trans. Proc.14:335, 1982

    Google Scholar 

  29. Opelz, G., Terasaki, P.I.: International study of histocompatibility in renal transplantation. Transplantation33:87, 1982

    Google Scholar 

  30. Waymack, J.P., Alexander, J.W.: Blood transfusion as an immunomodulator—A review. Comp. Immunol. Microbiol. Infect. Dis.9:177, 1986

    Google Scholar 

  31. Murphy, S.: The use of blood components in patients with malignancy. World J. Surg.11:20, 1987

    Google Scholar 

  32. Spratt, J.S.: Blood transfusion and surgery for cancer. Am. J. Surg.152:337, 1986

    Google Scholar 

  33. Francis, D.M.A., Shenton, B.K.: Blood transfusion and tumor growth; Evidence from laboratory animals. Lancet2:871, 1981

    Google Scholar 

  34. Francis, D.M.A., Shenton, B.K., Proud, G., Taylor, R.M.R.: Tumor growth and blood transfusion. J. Exp. Clin. Cancer Res.1:121, 1982

    Google Scholar 

  35. Oikawa, T., Hosokawa, M., Imamura, M., Sendo, F., Nakayama, M., Gotohda, E., Kodama, T., Kobayashi, H.: Anti-tumour immunity by normal allogenic blood transfusion in the rat. Clin. Exp. Immunol.27:549, 1977

    Google Scholar 

  36. Moffat, L.E.F., Sunderland, G.T.: Relation between recurrence of cancer and blood transfusion. Br. Med. J.291:971, 1985

    Google Scholar 

  37. 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.293:530, 1986

    Google Scholar 

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Affiliations

  1. Department of Surgery, University Hospital Leiden, P.O. Box 9600, 2300, RC Leiden, The Netherlands

    G. H. M. Kampschöer M.D., K. Maruyama M.D., M. Sasako M.D., T. Kinoshita M.D. & C. J. H. van de Velde M.D.

  2. National Cancer Center Hospital, Tokyo, Japan

    G. H. M. Kampschöer M.D., K. Maruyama M.D., M. Sasako M.D., T. Kinoshita M.D. & C. J. H. van de Velde M.D.

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  1. G. H. M. Kampschöer M.D.
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  2. K. Maruyama M.D.
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  3. M. Sasako M.D.
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  4. T. Kinoshita M.D.
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  5. C. J. H. van de Velde M.D.
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Kampschöer, G.H.M., Maruyama, K., Sasako, M. et al. The effects of blood transfusion on the prognosis of patients with gastric cancer. World J. Surg. 13, 637–643 (1989). https://doi.org/10.1007/BF01658891

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  • DOI: https://doi.org/10.1007/BF01658891

Keywords

  • Gastric Cancer
  • Blood Transfusion
  • Parmi
  • Relative Risk Ratio
  • Adverse Influence