Perioperative blood transfusion has a dose-dependent relationship with disease recurrence and survival in patients with non–small cell lung cancer Journal Article
| Authors: | Latif, M. J.; Tan, K. S.; Molena, D.; Huang, J.; Bott, M. J.; Park, B. J.; Adusumilli, P. S.; Rusch, V. W.; Bains, M. S.; Downey, R. J.; Jones, D. R.; Isbell, J. M. |
| Article Title: | Perioperative blood transfusion has a dose-dependent relationship with disease recurrence and survival in patients with non–small cell lung cancer |
| Abstract: | Objective: Perioperative blood transfusions have been implicated in decreased overall survival (OS) and disease-free survival (DFS) after resection for non–small cell lung cancer (NSCLC). We investigated the effects of single- and multiple-unit blood transfusions on OS, DFS, and recurrence after anatomic pulmonary resection. Methods: From January 1, 2000, to June 30, 2016, 5709 consecutive patients underwent pulmonary resection for NSCLC at our institution. Exclusion criteria were stage IIIB-IV disease, incomplete resections, ill-defined histologic subtypes, and nonanatomic wedge resections. For the 0 versus single-unit analysis, propensity scores were calculated from a logistic regression model that predicted the probability of patients receiving a single-unit transfusion. The resulting matching weights were incorporated into Cox models for OS, DFS, and cumulative incidence of recurrence, to compare no versus single-unit blood transfusion. We determined whether increasing numbers of blood transfusions influenced survival or recurrence using multivariable Cox models. Results: Approximately 10% of patients received perioperative blood transfusion (median follow-up, 7.46 years [25th-75th percentile, 3.98-11.8]). There was no difference in OS, DFS, or cumulative incidence of recurrence between patients receiving no transfusion and those receiving single-unit transfusion (P > .05). However, a dose–response relationship was observed, demonstrating worse OS (overall P < .001), DFS (overall P < .001), and recurrence (overall P = .010) with increasing units of blood transfused. Conclusions: Although a single-unit blood transfusion did not affect survival in patients undergoing resection for NSCLC, greater unit perioperative blood transfusions were associated with significantly decreased long-term outcomes in a dose-dependent manner, suggesting avoidance or minimization of transfusions could improve long-term survival after lung resection. © 2019 The American Association for Thoracic Surgery |
| Keywords: | survival; lung cancer; recurrence; lobectomy; transfusion; segmentectomy; propensity-score matching |
| Journal Title: | Journal of Thoracic and Cardiovascular Surgery |
| Volume: | 157 |
| Issue: | 6 |
| ISSN: | 0022-5223 |
| Publisher: | Mosby Elsevier |
| Date Published: | 2019-06-01 |
| Start Page: | 2469 |
| End Page: | 2477.e10 |
| Language: | English |
| DOI: | 10.1016/j.jtcvs.2018.12.109 |
| PUBMED: | 30902468 |
| PROVIDER: | scopus |
| PMCID: | PMC6626561 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 June 2019 -- Source: Scopus |
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