The association of perioperative blood transfusion with colorectal cancer recurrence.

The relationship between blood transfusion, disease-free survival, and other potential prognostic factors was prospectively studied in 339 consecutive patients with colorectal cancer. Admission and discharge hematocrit, Dukes' stage, and blood loss were significantly related to both blood transfusion and disease-free survival. Using Cox proportional hazards model, however, the association of transfusion with disease-free survival was significant (p = 0.0196) after controlling for age, sex, blood loss, procedure, tumor differentiation, stage, admission hematocrit, duration of surgery, length of the specimen, and tumor size. Dukes' stage (p < 0.0001) and blood transfusion (p < 0.0001) were the only variables independently related to disease-free survival. Forty per cent (44) of the 110 patients who received transfusions developed cancer recurrence, compared with 22% (50) of the 229 patients who did not receive blood (p < 0.0001). Five-year disease-free survival of the transfused patients was 57%, compared with 77% for nontransfused patients. Patients who developed recurrence received an average of twice as much blood as patients without recurrence (1.26 versus 0.61 units, p = 0.0128). Perioperative blood transfusion is a significant independent prognostic factor for colorectal cancer.     

Effect of perioperative blood transfusion on prostate cancer recurrence

BACKGROUND: Transfusion may predispose patients to an increased risk of tumor recurrence following solid organ surgery. Lung and colon cancer studies suggest that blood transfusions promote tumor growth or distant metastasis possibly due to immunosuppression. Blood loss can be high during radical retropubic prostatectomy necessitating intraoperative and postoperative blood transfusion. The impact of blood transfusion on recurrence risk after radical retropubic prostatectomy remains uncertain. OBJECTIVE: To determine the influence of allogeneic or autologous blood transfusion on prostate cancer recurrence in men undergoing radical retropubic prostatectomy and assess their prognostic significance using serum prostate-specific antigen (PSA) as an intermediate endpoint. METHODS: Six hundred eleven men treated from 1987 to the present have had all clinical and follow-up data entered prospectively into a clinical database; 242 (40%) did not receive blood transfusion, 252 (41%) received autologous blood transfusion, and 117 (19%) received allogeneic blood transfusion. Biochemical failure was defined as PSA > 0.3 ng/ml on any follow-up visit. ANOVA, chi-square, and survival analyses were used to evaluate clinical characteristics and biochemical progression-free survival. RESULTS: Patients participated for a mean of 44 months, range 1 to 170 months, until biochemical progression (78) or July 1, 2005 (533). Average estimated blood loss was 929 ml, 1573 ml, and 2,818 ml in the no blood transfusion, autologous blood transfusion, and allogeneic blood transfusion groups, respectively (P = 0.001). Patients in the allogeneic transfusion group were older, had higher preoperative PSA, higher stage disease, and greater blood loss. Biochemical failure rates were similar in the 3 groups (P = 0.42). Biochemical failure at 5 years occurred in 14% of men who did not receive blood transfusion, 10% of men who received autologous blood transfusion, and 16% of men who received allogeneic blood transfusion. No patient suffered clinical progression or prostate cancer death. CONCLUSIONS: Autologous or allogeneic blood transfusions do not appear to influence the risk of biochemical failure in men with clinically localized prostate cancer treated with radical retropubic prostatectomy.     

A relationship between perioperative blood transfusion and recurrence of carcinoma of the sigmoid colon following potentially curative surgery.

Preoperative blood transfusions are used to improve graft survival in renal transplantation. If such an immunomodulating effect occurred in cancer surgery perioperative blood transfusion may be detrimental to patient outcome. A retrospective study of 68 patients undergoing potentially curative surgery for adenocarcinoma of the sigmoid colon, over a 10 year period was performed. Thirty-three patients (49%) had a perioperative blood transfusion of which two-thirds received either one or two units. Transfused patients had a poorer prognosis compared to non-transfused patients (0.28 and 0.53 five year product limit recurrence free fractions respectively; P less than 0.01 on generalised Savege test of entire recurrence free curves). Perioperative transfusion was the most sensitive prognostic indicator of recurrence on Cox proportional hazards regression analysis (relative risk 2.6; P less than 0.01, after adjustment for histological stage). Although a causal relationship is not proven, prospective work is urgently needed.     

Blood transfusion and recurrence of colorectal cancer.

Because perioperative blood transfusions have been shown to have an impaired effect on survival in patients with colorectal cancer, we examined retrospectively the records of 882 patients who had undergone curative operations: 170 patients had distant metastases at the time of operation. Of the 499 patients with colonic cancer 332 (67%) had received perioperative blood transfusions. The corresponding figure for the 213 patients with rectal cancer was 190 (89%). Colonic tumors recurred in 45% of the patients who received blood transfusions and in 39% of those who did not. Corresponding figures for tumors in the rectum were 54% and 55%. When dividing the patients with colonic cancer into different subgroups according to Dukes' grade we found differences in survival rates. The poorer survival for transfused patients was, however, only significant for those with Dukes' A tumors (p less than 0.05). This difference disappeared when the influence of age was eliminated. The estimated risk ratio of recurrence and death was 1.23 with the 95% confidence interval (0.99, 1.53) when taking Dukes' grade, current age and localization into account. Blood transfusion should be avoided if possible until adequate prospective studies have been carried out.     

Effect of perioperative blood transfusion on recurrence of colorectal cancer

The aim of the present study was to examine the outcome of 517 patients undergoing curative surgery for colonic and rectal cancer, and to compare the recurrence and mortality rates in transfused and non-transfused groups of patients. The two groups were evenly matched for age, sex, Dukes' stage and histological differentiation. There were significantly more rectal tumours in the transfused group (P less than 0.01), but the distribution of colonic lesions did not differ. Life table analysis revealed that the transfused patients had a 20 per cent greater probability of recurrence at 5 years (P less than 0.005) and there were 16 per cent more cancer related deaths (P less than 0.01). Even when all rectal cancers were excluded, a similar trend was seen for the colonic lesions: a 24 per cent greater probability of recurrence at 5 years (P less than 0.025) and 15 per cent more cancer related deaths (P less than 0.02). We conclude that blood transfusion may be associated with increased mortality and recurrence in patients undergoing curative surgery for colorectal cancer.     

High-risk human papillomavirus in mammary gland carcinomas and non-neoplastic tissues of Mexican women: no evidence supporting a cause and effect relationship

Human papillomavirus (HPV) has been implicated in breast carcinogenesis. Consecutive and non-selected mastectomy specimens from Mexican patients harboring breast carcinomas were sampled in order to look for the presence of HPV DNA.HPV-16 was detected in 6 (10%) of 60 breast carcinomas. Two of these also had HPV genome in adjacent non-neoplastic mammary-tissues. Seven cases had HPV DNA only in non-neoplastic tissue specimens. HPV DNA was also detected in 4 (25%) of 10 tumor-bed specimens without residual neoplastic lesions that were obtained from patients who underwent neoadjuvant chemotherapy or neoadjuvant chemotherapy/radiotherapy. HPV-positive tumors tended to be smaller in size, than HPV-negative tumors (p = 0.047). Histological distributions of HPV-positive and -negative cases showed no significant difference.Although all the HPV-16 DNA were found integrated, its low viral load rendered it difficult to incriminate this virus in breast carcinogenesis. However, the possibility that HPV infection occurred during carcinoma development cannot be ruled out.     

Peri-operative blood transfusion in relation to tumour recurrence and death after surgery for prostatic cancer.

Several reports have suggested that peri-operative blood transfusion promotes tumour recurrence and death after surgery for cancer. We have studied the effect of transfusion in 156 patients operated on for prostatic cancer. A retrospective review was made of the clinical, histopathological and transfusion data in their hospital records. Sixty patients received blood transfusions and 96 did not. The 5-year prostatic cancer specific survival rate was 0.56 in the transfused patients and 0.69 in the non-transfused group. The transfused patients had a higher prevalence of risk factors than did the non-transfused. When the differences in risk factors were accounted for by Cox regression analysis, peri-operative blood transfusion reduced the prostatic cancer death intensity by 36%. The study does not support the hypothesis that blood transfusion promotes recurrence following surgery for prostatic cancer.     

Beneficial effect of blood transfusion. Role of the time interval between the last transfusion and transplantation.

We analyzed the effect of blood transfusion (BT) on kidney allograft survival in 163 recipients. Transfused recipients (121) had better graft outcome than those never transfused (42), the difference being statistically significant at 3, 6, 12, and 24 months; however, the transfused group had a longer period of hemodialysis (P = 0.01). HLA antigen distribution does not bias the data. The group who had received the last BT within 3 months before grafting had a significantly better graft outcome than the nontransfused group (P less than 0.05 at 3, 6, and 24 months). They also did better (but not significantly) than the group who had been transfused more than 6 months before grafting. The group receiving two to five BTs had the highest rate of graft survival (P less than 0.05, 0.001, and 0.05 at 6, 12, and 24 months) as compared to the nontransfused. Practical suggestions for systematic BTs during hemodialysis are made.     

异体输血与肝癌切除术后转移复发的研究进展

输血仍旧在肝癌的外科治疗中占有重要地位.然而异体输血可能导致受血者免疫抑制,阻碍机体对肿瘤的免疫应答,促进肿瘤转移复发.如何解决这一矛盾,值得我们的关注.我们要研究异体输血与肝癌肝切除术后转移复发的关系,从而找出对策,改善肝癌患者预后水平.     

Effect of perioperative blood transfusion on recurrence and death after mastectomy for breast cancer

A recent report suggested that perioperative blood transfusion doubles the recurrence rate of breast cancer after mastectomy. In the present retrospective study the effect of transfusion on cancer recurrence and death after mastectomy was investigated in 96 women, 27 with and 69 without blood transfusion. The overall survival rates, the breast-cancer-specific survival and the recurrence-free survival rates were similar in the two groups. The study thus does not support the hypothesis that perioperative blood transfusion promotes recurrence of breast cancer.     

The relationship between perioperative blood transfusion and overall mortality in patients undergoing radical cystectomy for bladder cancer

ObjectivesThe relationship between perioperative blood transfusion (PBT) and oncologic outcomes is controversial. In patients undergoing surgery for colon cancer and several other solid malignancies, PBT has been associated with an increased risk of mortality. Yet, the urologic literature has a paucity of data addressing this topic. We sought to evaluate whether PBT affects overall survival following radical cystectomy (RC) for patients with bladder cancer.MethodsThe medical records of 777 consecutive patients undergoing RC for urothelial carcinoma of the bladder were reviewed. PBT was defined as transfusion of red blood cells during RC or within the postoperative hospitalization. The primary outcome was overall survival. Clinical and pathologic variables were compared using χ² tests, and Cox multivariate survival analyses were performed.ResultsA total of 323 patients (41.6%) underwent PBT. In the univariate analysis, PBT was associated with increased overall mortality (HR 1.40, 95% CI 1.11–1.78). Additionally, an independent association was demonstrated in a non-transformed Cox regression model (HR, 95% CI 1.01–1.36) but not in a model utilizing restricted cubic splines (HR 1.03, 95% CI 0.77–1.38). The c-index was 0.78 for the first model and 0.79 for the second.ConclusionsIn a traditional multivariate model, mirroring those that have been applied to this question in the general surgery literature, we demonstrated an association between PBT and overall mortality after RC. However, this relationship is not observed in a second statistical model. Given the complex nature of adequately controlling for confounding factors in studies of PBT, a prospective study will be necessary to fully elucidate the independent risks associated with PBT.     

Relationship between blood transfusion and tumour behaviour.

Blood transfusion results in significant alterations in some parameters of immune function. Because some human cancers appear to stimulate immune responses and may be influenced by host immunity, the possibility arises that transfusion could alter the behaviour of tumours. Experimental studies indicate that allogeneic transfusion can directly alter tumour growth in some circumstances, but at present studies of human cancers do not provide evidence of a causal association between transfusion and tumour growth.     

Large bowel cancer: the effect of perioperative blood transfusion on outcome.

Perioperative blood transfusion has been reported to adversely affect survival in cancer patients, but the evidence is inconclusive and may be an epiphenomenon. From the Large Bowel Cancer Project, 961 patients who underwent curative resection and left hospital alive have been reviewed to compare the effect of perioperative blood transfusion on outcome; 591 patients (61%) had been given a blood transfusion while 370 (39%) had not been transfused. Some clinical variables were equally distributed between the two groups; ie age, sex, obstruction, perforation, tumour differentiation. Three other variables known to influence patient prognosis were not equally distributed, ie tumour site, Dukes' stage and tumour mobility. Patients with tumours of the rectum and rectosigmoid, with Dukes' stage C lesions and with some degree of tumour fixation were more likely to have received blood transfusions. Using the logrank method of multivariate analysis to allow for differences in distribution of all those variables known to affect prognosis, there was no survival disadvantage for those patients who had received perioperative blood transfusion. Furthermore, there were no overall differences between the two groups of patients in their risk of developing local tumour recurrence or distant metastases. The distribution of metastases differed: in the 'transfused' group only 37% of distant metastases were found in the liver, while 71% were found in this site in the 'not transfused' group (chi 2 = 18.46, d.f. = 1, P less than 0.001). By contrast, there was a larger proportion of patients with lung metastases in the transfused group (27% vs 11%) (chi 2 = 5.59, d.f. = 1, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

The association of allogeneic blood transfusion and the recurrence of hepatic cancer after surgical resection

There is conflicting evidence whether allogeneic blood transfusion influences survival or cancer recurrence after resection of hepatocellular cancer. We followed up 1469 patients who had undergone hepatocellular resection for a median (IQR [range]) of 45 (21–78 [0–162]) months, of whom 626 (43%) had had blood transfusion within 7 days of surgery. Both disease-free survival and patient survival were measured using a proportional hazards regression model and inverse probability of treatment weighting. We used restricted cubic splines for the association of the number of packed red blood cell units transfused with cancer recurrence and survival. We found that peri-operative blood transfusion was independently associated with survival and cancer recurrence after resection of hepatocellular carcinoma. Adjusted hazard ratios (95%CI) for the association of blood transfusion with cancer recurrence and all-cause mortality were 1.3 (1.1–1.4) and 1.9 (1.6–2.3), p < 0.001 for both. With more units transfused cancer recurrence was more likely and survival was shorter. The association of the number of transfused units was non-linear for cancer recurrence and linear response for all-cause mortality.