Skip to main content
SpringerLink
Log in

Transfusion Alert for Patients with Curable Cancer

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Perioperative transfusion (POT) is a negative prognostic factor for outcome in cancer patients undergoing surgery, and splenectomy (SPL) has been suggested to help obviate this negative effect. However, the prognostic independence among related factors and clinical significance of the interaction remains elusive.

Patients and methods

Between January 1, 1990 and January 31, 2005, a total of 200 patients with proximal gastric cancer classified as having stage IB to III disease after curative resection were enrolled at Kitasato University Hospital in a retrospective manner, according to a previous report by Weitz et al.

Findings

POT was reconfirmed to be a potent univariate prognostic predictor in this model (p < 0.0001). The tendency was further augmented in patients without SPL, suggesting that SPL can counteract the negative aspects of POT. A multivariate analysis including related factors revealed that POT was one of the most potent independent prognostic factors, as were stage and age. Stratification analysis following the JCGC staging system revealed that the outstanding prognostic difference according to POT was recognized in patients anticipated to be cured, such as those with stage IB (p = 0.012) or II (p = 0.003) but not stage III. SPL could dramatically improve the prognosis with POT in stage IB patients but modestly if at all in those with stage II or III.

Interpretation

Our findings support the need for a clinical alert against POT throughout the course of cancer treatment, especially for curable disease; thus, POT should be carefully considered from an oncologic point of view. Appropriate strategies to minimize POT should be urgently developed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Busch OR, Hop WC, Hoynck van Papendrecht MA, et al. (1993) Blood transfusions and prognosis in colorectal cancer. N Engl J Med 328(19):1372–1376

    Article  PubMed  CAS  Google Scholar 

  2. Houbiers JG, Brand A, van de Watering LM, 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 

  3. Lapierre V, Auperin A, Tiberghien P (1998) Transfusion-induced immunomodulation following cancer surgery: fact or fiction? J Natl Cancer Inst 90(8):573–580

    Article  PubMed  CAS  Google Scholar 

  4. Jensen LS, Puho E, Pedersen L, et al. (2005) Long-term survival after colorectal surgery associated with buffy-coat-poor and leucocyte-depleted blood transfusion: a follow-up study. Lancet 365(9460):681–682

    PubMed  Google Scholar 

  5. Rosenberg SA, Seipp CA, White DE, et al. (1985) 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 3(5):698–709

    PubMed  CAS  Google Scholar 

  6. Fong Y, Karpeh M, Mayer K, et al. (1994) Association of perioperative transfusion with poor outcome in resection of gastric adenocarcinoma. Am J Surg 167:256–260

    Article  PubMed  CAS  Google Scholar 

  7. Maeta M, Shimizu N, Oka A, et al. (1994) Perioperative allogeneic blood transfusion exacerbates surgical stress-induced postoperative immunosuppression and has a negative effect on prognosis in petients with gastric cancer. J Surg Oncol 55:149–153

    Article  PubMed  CAS  Google Scholar 

  8. Hyung WJ, Noh SH, Shin DW, et al. (2002) Adverse effects of perioperative transfusion on patients with stage III and IV gastric cancer. Ann Surg Oncol 9(1):5–12

    Article  PubMed  Google Scholar 

  9. Weitz J, D’Angelica M, Gonen M, et al. (2003) Interaction of splenectomy and perioperative blood transfusions on prognosis of patients with proximal gastric and gastroesophageal junction cancer. J Clin Oncol 21(24):4597–4603

    Article  PubMed  Google Scholar 

  10. Nio Y, Tsubono M, Kawabata K, et al. (1993) Comparison of survival curves of gastric cancer patients after surgery according to the UICC stage classification and the General Rules for Gastric Cancer Study by the Japanese Research Society for gastric cancer. Ann Surg 218(1):47–53

    Article  PubMed  CAS  Google Scholar 

  11. Ikeguchi M, Murakami D, Kanaji S, et al. (2004) Lymph node metastasis of gastric cancer: comparison of Union International Contra Cancer and Japanese systems. ANZ J Surg 74(10):852–854

    Article  PubMed  Google Scholar 

  12. Nio Y, Yamasawa K, Yamaguchi K, et al. (2003) Problems in the N-classification of the new 1997 UICC TNM stage classification for gastric cancer: an analysis over 10 years’ outcome of Japanese patients. Anticancer Res 23(1B):697–705

    PubMed  Google Scholar 

  13. Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–481

    Article  Google Scholar 

  14. Cox DR (1972) Regression models and life-tables. J R Stat Soc (B) 34:187–220

    Google Scholar 

  15. Al-Mehdi AB, Tozawa K, Fisher AB, et al. (2000) Intravascular origin of metastasis from the proliferation of endothelium-attached tumor cells: a new model for metastasis. Nat Med 6(1):100–102

    Article  PubMed  CAS  Google Scholar 

  16. Bohlius J, Langensiepen S, Schwarzer G, et al. (2005) Recombinant human erythropoietin and overall survival in cancer patients: results of a comprehensive meta-analysis. J Natl Cancer Inst 97(7):489–498

    Article  PubMed  CAS  Google Scholar 

  17. Miller CB, Platanias LC, Mills SR, et al. (1992) Phase I-II trial of erythropoietin in the treatment of cisplatin-associated anemia. J Natl Cancer Inst 98–103

  18. Case DC Jr, Bukowski RM, Carey RW, et al. (1993) Recombinant human erythropoietin therapy for anemic cancer patients on combination chemotherapy. J Natl Cancer Inst 85(10):801–806

    Article  PubMed  Google Scholar 

  19. Seidenfeld J, Piper M, Flamm C, et al. (2001) Epoetin treatment of anemia associated with cancer therapy: a systemic review and meta-analysis of controlled clinical trials. J Natl Cancer Inst 93(16):1204–1214

    Article  PubMed  CAS  Google Scholar 

  20. Vansteenkiste J, Pirker R, Massuti B, et al. (2002) Double-blind, placebo-controlled, randamized phase III trial of darbepoietin alfa in lung cancer patients receiving chemotherapy. J Natl Cancer Inst 94(16):1211–1220

    PubMed  CAS  Google Scholar 

  21. Cella D, Zagari MJ, Vandoros C, et al. (2003) Epoetin alfa treatment results in clinically significant improvements in quality of life in anemic cancer patients when referenced to the general population. J Clin Oncol 21(2):366–373

    Article  PubMed  Google Scholar 

  22. Witzig TE, Silberstein PT, Loprinzi CL, et al. (2005) Phase III, randomized, double-blind study of epoetin alfa compared with placebo in anemic patients receiving chemotherapy. J Clin Oncol 23(12):2606–2617

    Article  PubMed  CAS  Google Scholar 

  23. Chang J, Couture F, Young S, et al. (2005) Weekly epoietin alfa maintains hemoglobin, improves quality of life, and reduces transfusion in breast cancer patients receiving chemotherapy. J Clin Oncol 23(12):2597–2605

    Article  PubMed  CAS  Google Scholar 

  24. Steensma DP, Molina R, Sloan JA, et al. (2006) Phase III study of two different dosing schedules of erythropoietin in anemic patients with cancer. J Clin Oncol 24(7):1079–1089

    Article  PubMed  CAS  Google Scholar 

  25. Glaspy J, Vadhan-Raj S, Patel R, et al. (2006) Randamized comparison of every-2-week darbepoietin alfa and weekly epoietin alfa for the treatment of chemotherapy-induced anemia: the 20030125 Study Group Trial. J Clin Oncol 24(15):2290–2297

    Article  PubMed  CAS  Google Scholar 

  26. Bohlius J, Wilson J, Seidenfeld J, et al. (2006) Recombinant human erythropoietins and cancer patients: updated meta-analysis of 57 studies including 9353 patients. J Natl Cancer Inst 98(10):708–714

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Kitasato University Hospital, Kitasato 1-15-1, Sagamihara, 228-8555, Kanagawa, Japan

    Keishi Yamashita, Shinichi Sakuramoto, Shiroh Kikuchi, Natsuya Katada, Nobuyuki Kobayashi & Masahiko Watanabe

Authors
  1. Keishi Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shinichi Sakuramoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shiroh Kikuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Natsuya Katada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nobuyuki Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masahiko Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masahiko Watanabe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yamashita, K., Sakuramoto, S., Kikuchi, S. et al. Transfusion Alert for Patients with Curable Cancer. World J Surg 31, 2315–2322 (2007). https://doi.org/10.1007/s00268-007-9237-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-007-9237-6

Keywords

Search

Navigation