Blood transfusion and survival for resected adrenocortical carcinoma: A study from the United States adrenocortical carcinoma group

Caroline E. Poorman, Lauren M. Postlewait, Cecilia G. Ethun, Thuy B. Tran, Jason D Prescott, Timothy M. Pawlik, Tracy S. Wang, Jason Glenn, Ioannis Hatzaras, Rivfka Shenoy, John E. Phay, Kara Keplinger, Ryan C. Fields, Linda X. Jin, Sharon M. Weber, Ahmed Salem, Jason K. Sicklick, Shady Gad, Adam C. Yopp, John C. Mansour & 9 others Quan Yang Duh, Natalie Seiser, Carmen C. Solorzano, Colleen M. Kiernan, Konstantinos I. Votanopoulos, Edward A. Levine, Charles A. Staley, George A. Poultsides, Shishir K. Maithel

Research output: Contribution to journalArticle

Abstract

Perioperative blood transfusion is associated with decreased survival in pancreatic, gastric, and liver cancer. The effect of transfusion in adrenocortical carcinoma (ACC) has not been studied. Patients with available transfusion data undergoing curative-intent resection of ACC from 1993 to 2014 at 13 institutions comprising the United States Adrenocortical Carcinoma Group were included. Factors associated with blood transfusion were determined. Primary and secondary end points were recurrence-free survival (RFS) and overall survival (OS), respectively. Out of 265 patients, 149 were included for analysis. Out of these, 57 patients (38.3%) received perioperative transfusions. Compared to nontransfused patients, transfused patients more commonly had stage 4 disease (46% vs 24%, P = 0.01), larger tumors (15.8 vs 10.2 cm, P < 0.001), inferior vena cava involvement (24.6% vs 5.4%, P = 0.002), additional organ resection (78.9% vs 36.3%, P < 0.001), and major complications (29% vs 2%, P < 0.001). Transfusion was associated with decreased RFS (8.9 vs 24.7 months, P = 0.006) and OS (22.8 vs 91.0 months, P < 0.001). On univariate Cox regression, transfusion, stage IV, hormonal hypersecretion, and adjuvant therapy were associated with decreased RFS. On multivariable analysis, only transfusion [hazard ratio (HR) 5 1.7, 95% confidence interval (CI) 51.0-2.9, P = 0.04], stage IV (HR 5 3.2, 95% CI 5 1.7-5.9, P < 0.001), and hormonal hypersecretion (HR 5 2.6, 95% CI 5 1.5-4.2, P < 0.001) were associated with worse RFS. When applying this model to OS, similar associations were seen (transfusion HR 5 2.0, 95% CI 5 1.1-3.8, P = 0.02; stage 4 HR 5 6.2, 95% CI 5 3.1-12.4, P < 0.001; hormonal hypersecretion HR 5 3.5, 95% CI 5 1.9-6.4, P < 0.001). There was no difference in outcomes between patients who received 1 to 2 units versus >2 units of packed red blood cells in median RFS (8.9 vs 8.4 months, P = 0.95) or OS (26.5 vs 18.6 months, P = 0.63). Perioperative transfusion is associated with earlier recurrence and decreased survival after curative-intent resection of ACC. Strategies and protocols to minimize blood transfusion should be developed and followed.

LanguageEnglish (US)
Pages761-768
Number of pages8
JournalAmerican Surgeon
Volume83
Issue number7
StatePublished - Jul 1 2017

Fingerprint

Adrenocortical Carcinoma
Blood Transfusion
Survival
Recurrence
Liver Neoplasms
Pancreatic Neoplasms
Stomach Neoplasms
Erythrocytes
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Poorman, C. E., Postlewait, L. M., Ethun, C. G., Tran, T. B., Prescott, J. D., Pawlik, T. M., ... Maithel, S. K. (2017). Blood transfusion and survival for resected adrenocortical carcinoma: A study from the United States adrenocortical carcinoma group. American Surgeon, 83(7), 761-768.

Blood transfusion and survival for resected adrenocortical carcinoma : A study from the United States adrenocortical carcinoma group. / Poorman, Caroline E.; Postlewait, Lauren M.; Ethun, Cecilia G.; Tran, Thuy B.; Prescott, Jason D; Pawlik, Timothy M.; Wang, Tracy S.; Glenn, Jason; Hatzaras, Ioannis; Shenoy, Rivfka; Phay, John E.; Keplinger, Kara; Fields, Ryan C.; Jin, Linda X.; Weber, Sharon M.; Salem, Ahmed; Sicklick, Jason K.; Gad, Shady; Yopp, Adam C.; Mansour, John C.; Duh, Quan Yang; Seiser, Natalie; Solorzano, Carmen C.; Kiernan, Colleen M.; Votanopoulos, Konstantinos I.; Levine, Edward A.; Staley, Charles A.; Poultsides, George A.; Maithel, Shishir K.

In: American Surgeon, Vol. 83, No. 7, 01.07.2017, p. 761-768.

Research output: Contribution to journalArticle

Poorman, CE, Postlewait, LM, Ethun, CG, Tran, TB, Prescott, JD, Pawlik, TM, Wang, TS, Glenn, J, Hatzaras, I, Shenoy, R, Phay, JE, Keplinger, K, Fields, RC, Jin, LX, Weber, SM, Salem, A, Sicklick, JK, Gad, S, Yopp, AC, Mansour, JC, Duh, QY, Seiser, N, Solorzano, CC, Kiernan, CM, Votanopoulos, KI, Levine, EA, Staley, CA, Poultsides, GA & Maithel, SK 2017, 'Blood transfusion and survival for resected adrenocortical carcinoma: A study from the United States adrenocortical carcinoma group' American Surgeon, vol. 83, no. 7, pp. 761-768.
Poorman, Caroline E. ; Postlewait, Lauren M. ; Ethun, Cecilia G. ; Tran, Thuy B. ; Prescott, Jason D ; Pawlik, Timothy M. ; Wang, Tracy S. ; Glenn, Jason ; Hatzaras, Ioannis ; Shenoy, Rivfka ; Phay, John E. ; Keplinger, Kara ; Fields, Ryan C. ; Jin, Linda X. ; Weber, Sharon M. ; Salem, Ahmed ; Sicklick, Jason K. ; Gad, Shady ; Yopp, Adam C. ; Mansour, John C. ; Duh, Quan Yang ; Seiser, Natalie ; Solorzano, Carmen C. ; Kiernan, Colleen M. ; Votanopoulos, Konstantinos I. ; Levine, Edward A. ; Staley, Charles A. ; Poultsides, George A. ; Maithel, Shishir K. / Blood transfusion and survival for resected adrenocortical carcinoma : A study from the United States adrenocortical carcinoma group. In: American Surgeon. 2017 ; Vol. 83, No. 7. pp. 761-768.
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title = "Blood transfusion and survival for resected adrenocortical carcinoma: A study from the United States adrenocortical carcinoma group",
abstract = "Perioperative blood transfusion is associated with decreased survival in pancreatic, gastric, and liver cancer. The effect of transfusion in adrenocortical carcinoma (ACC) has not been studied. Patients with available transfusion data undergoing curative-intent resection of ACC from 1993 to 2014 at 13 institutions comprising the United States Adrenocortical Carcinoma Group were included. Factors associated with blood transfusion were determined. Primary and secondary end points were recurrence-free survival (RFS) and overall survival (OS), respectively. Out of 265 patients, 149 were included for analysis. Out of these, 57 patients (38.3{\%}) received perioperative transfusions. Compared to nontransfused patients, transfused patients more commonly had stage 4 disease (46{\%} vs 24{\%}, P = 0.01), larger tumors (15.8 vs 10.2 cm, P < 0.001), inferior vena cava involvement (24.6{\%} vs 5.4{\%}, P = 0.002), additional organ resection (78.9{\%} vs 36.3{\%}, P < 0.001), and major complications (29{\%} vs 2{\%}, P < 0.001). Transfusion was associated with decreased RFS (8.9 vs 24.7 months, P = 0.006) and OS (22.8 vs 91.0 months, P < 0.001). On univariate Cox regression, transfusion, stage IV, hormonal hypersecretion, and adjuvant therapy were associated with decreased RFS. On multivariable analysis, only transfusion [hazard ratio (HR) 5 1.7, 95{\%} confidence interval (CI) 51.0-2.9, P = 0.04], stage IV (HR 5 3.2, 95{\%} CI 5 1.7-5.9, P < 0.001), and hormonal hypersecretion (HR 5 2.6, 95{\%} CI 5 1.5-4.2, P < 0.001) were associated with worse RFS. When applying this model to OS, similar associations were seen (transfusion HR 5 2.0, 95{\%} CI 5 1.1-3.8, P = 0.02; stage 4 HR 5 6.2, 95{\%} CI 5 3.1-12.4, P < 0.001; hormonal hypersecretion HR 5 3.5, 95{\%} CI 5 1.9-6.4, P < 0.001). There was no difference in outcomes between patients who received 1 to 2 units versus >2 units of packed red blood cells in median RFS (8.9 vs 8.4 months, P = 0.95) or OS (26.5 vs 18.6 months, P = 0.63). Perioperative transfusion is associated with earlier recurrence and decreased survival after curative-intent resection of ACC. Strategies and protocols to minimize blood transfusion should be developed and followed.",
author = "Poorman, {Caroline E.} and Postlewait, {Lauren M.} and Ethun, {Cecilia G.} and Tran, {Thuy B.} and Prescott, {Jason D} and Pawlik, {Timothy M.} and Wang, {Tracy S.} and Jason Glenn and Ioannis Hatzaras and Rivfka Shenoy and Phay, {John E.} and Kara Keplinger and Fields, {Ryan C.} and Jin, {Linda X.} and Weber, {Sharon M.} and Ahmed Salem and Sicklick, {Jason K.} and Shady Gad and Yopp, {Adam C.} and Mansour, {John C.} and Duh, {Quan Yang} and Natalie Seiser and Solorzano, {Carmen C.} and Kiernan, {Colleen M.} and Votanopoulos, {Konstantinos I.} and Levine, {Edward A.} and Staley, {Charles A.} and Poultsides, {George A.} and Maithel, {Shishir K.}",
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T1 - Blood transfusion and survival for resected adrenocortical carcinoma

T2 - American Surgeon

AU - Poorman, Caroline E.

AU - Postlewait, Lauren M.

AU - Ethun, Cecilia G.

AU - Tran, Thuy B.

AU - Prescott, Jason D

AU - Pawlik, Timothy M.

AU - Wang, Tracy S.

AU - Glenn, Jason

AU - Hatzaras, Ioannis

AU - Shenoy, Rivfka

AU - Phay, John E.

AU - Keplinger, Kara

AU - Fields, Ryan C.

AU - Jin, Linda X.

AU - Weber, Sharon M.

AU - Salem, Ahmed

AU - Sicklick, Jason K.

AU - Gad, Shady

AU - Yopp, Adam C.

AU - Mansour, John C.

AU - Duh, Quan Yang

AU - Seiser, Natalie

AU - Solorzano, Carmen C.

AU - Kiernan, Colleen M.

AU - Votanopoulos, Konstantinos I.

AU - Levine, Edward A.

AU - Staley, Charles A.

AU - Poultsides, George A.

AU - Maithel, Shishir K.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Perioperative blood transfusion is associated with decreased survival in pancreatic, gastric, and liver cancer. The effect of transfusion in adrenocortical carcinoma (ACC) has not been studied. Patients with available transfusion data undergoing curative-intent resection of ACC from 1993 to 2014 at 13 institutions comprising the United States Adrenocortical Carcinoma Group were included. Factors associated with blood transfusion were determined. Primary and secondary end points were recurrence-free survival (RFS) and overall survival (OS), respectively. Out of 265 patients, 149 were included for analysis. Out of these, 57 patients (38.3%) received perioperative transfusions. Compared to nontransfused patients, transfused patients more commonly had stage 4 disease (46% vs 24%, P = 0.01), larger tumors (15.8 vs 10.2 cm, P < 0.001), inferior vena cava involvement (24.6% vs 5.4%, P = 0.002), additional organ resection (78.9% vs 36.3%, P < 0.001), and major complications (29% vs 2%, P < 0.001). Transfusion was associated with decreased RFS (8.9 vs 24.7 months, P = 0.006) and OS (22.8 vs 91.0 months, P < 0.001). On univariate Cox regression, transfusion, stage IV, hormonal hypersecretion, and adjuvant therapy were associated with decreased RFS. On multivariable analysis, only transfusion [hazard ratio (HR) 5 1.7, 95% confidence interval (CI) 51.0-2.9, P = 0.04], stage IV (HR 5 3.2, 95% CI 5 1.7-5.9, P < 0.001), and hormonal hypersecretion (HR 5 2.6, 95% CI 5 1.5-4.2, P < 0.001) were associated with worse RFS. When applying this model to OS, similar associations were seen (transfusion HR 5 2.0, 95% CI 5 1.1-3.8, P = 0.02; stage 4 HR 5 6.2, 95% CI 5 3.1-12.4, P < 0.001; hormonal hypersecretion HR 5 3.5, 95% CI 5 1.9-6.4, P < 0.001). There was no difference in outcomes between patients who received 1 to 2 units versus >2 units of packed red blood cells in median RFS (8.9 vs 8.4 months, P = 0.95) or OS (26.5 vs 18.6 months, P = 0.63). Perioperative transfusion is associated with earlier recurrence and decreased survival after curative-intent resection of ACC. Strategies and protocols to minimize blood transfusion should be developed and followed.

AB - Perioperative blood transfusion is associated with decreased survival in pancreatic, gastric, and liver cancer. The effect of transfusion in adrenocortical carcinoma (ACC) has not been studied. Patients with available transfusion data undergoing curative-intent resection of ACC from 1993 to 2014 at 13 institutions comprising the United States Adrenocortical Carcinoma Group were included. Factors associated with blood transfusion were determined. Primary and secondary end points were recurrence-free survival (RFS) and overall survival (OS), respectively. Out of 265 patients, 149 were included for analysis. Out of these, 57 patients (38.3%) received perioperative transfusions. Compared to nontransfused patients, transfused patients more commonly had stage 4 disease (46% vs 24%, P = 0.01), larger tumors (15.8 vs 10.2 cm, P < 0.001), inferior vena cava involvement (24.6% vs 5.4%, P = 0.002), additional organ resection (78.9% vs 36.3%, P < 0.001), and major complications (29% vs 2%, P < 0.001). Transfusion was associated with decreased RFS (8.9 vs 24.7 months, P = 0.006) and OS (22.8 vs 91.0 months, P < 0.001). On univariate Cox regression, transfusion, stage IV, hormonal hypersecretion, and adjuvant therapy were associated with decreased RFS. On multivariable analysis, only transfusion [hazard ratio (HR) 5 1.7, 95% confidence interval (CI) 51.0-2.9, P = 0.04], stage IV (HR 5 3.2, 95% CI 5 1.7-5.9, P < 0.001), and hormonal hypersecretion (HR 5 2.6, 95% CI 5 1.5-4.2, P < 0.001) were associated with worse RFS. When applying this model to OS, similar associations were seen (transfusion HR 5 2.0, 95% CI 5 1.1-3.8, P = 0.02; stage 4 HR 5 6.2, 95% CI 5 3.1-12.4, P < 0.001; hormonal hypersecretion HR 5 3.5, 95% CI 5 1.9-6.4, P < 0.001). There was no difference in outcomes between patients who received 1 to 2 units versus >2 units of packed red blood cells in median RFS (8.9 vs 8.4 months, P = 0.95) or OS (26.5 vs 18.6 months, P = 0.63). Perioperative transfusion is associated with earlier recurrence and decreased survival after curative-intent resection of ACC. Strategies and protocols to minimize blood transfusion should be developed and followed.

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