Effect of Perioperative Transfusion on Recurrence and Survival after Gastric Cancer Resection

A 7-Institution Analysis of 765 Patients from the US Gastric Cancer Collaborative

Malcolm H. Squires, David A. Kooby, George A. Poultsides, Sharon M. Weber, Mark Bloomston, Ryan C. Fields, Timothy M. Pawlik, Konstantinos I. Votanopoulos, Carl R. Schmidt, Aslam Ejaz, Alexandra W. Acher, David J. Worhunsky, Neil Saunders, Edward A. Levine, Linda X. Jin, Clifford S. Cho, Emily R. Winslow, Maria C. Russell, Charles A. Staley, Shishir K. Maithel

Research output: Contribution to journalArticle

Abstract

Background The prognostic effect of perioperative blood transfusion on recurrence and survival in patients undergoing resection of gastric adenocarcinoma (GAC) remains controversial. Study Design All patients who underwent resection for GAC from 2000 to 2012 at the 7 institutions of the US Gastric Cancer Collaborative were identified. The effect of transfusion on recurrence-free (RFS) and overall survival (OS) in the context of adverse clinicopathologic variables was examined by univariate and multivariate regression analyses. Results Of 965 patients, 765 underwent curative intent R0 resection. Median follow-up was 44 months; 30-day mortalities were excluded. Median estimated blood loss (EBL) was 200 mL, and 168 patients (22%) received perioperative allogeneic blood transfusions. Transfused patients were less likely to receive adjuvant therapy (44% vs 56%; p = 0.01). Transfusion was associated with significantly decreased median RFS (13.5 vs 37.2 months, p <0.001). Median OS was similarly decreased in patients receiving transfusions (18.6 vs 49.8 months, p <0.001). On multivariate analysis, transfusion remained an independent risk factor for decreased RFS (hazard ratio [HR] 1.63; 95% CI 1.13 to 2.37; p = 0.010) and decreased OS (HR 1.79; 95% CI 1.21 to 2.67; p = 0.004), regardless of EBL or need for splenectomy. Timing (intraoperative vs postoperative) and volume of transfusion did not alter the negative prognostic effect of transfusion on survival. Conclusions Perioperative allogeneic blood transfusion is associated with decreased RFS and OS after resection of gastric cancer, independent of adverse clinicopathologic factors. This supports the judicious use of perioperative transfusion during resection of gastric cancer.

Original languageEnglish (US)
Article number7935
Pages (from-to)767-777
Number of pages11
JournalJournal of the American College of Surgeons
Volume221
Issue number3
DOIs
StatePublished - Sep 1 2015

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Stomach Neoplasms
Recurrence
Survival
Blood Transfusion
Stomach
Adenocarcinoma
Multivariate Analysis
Splenectomy
Regression Analysis
Mortality

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Effect of Perioperative Transfusion on Recurrence and Survival after Gastric Cancer Resection : A 7-Institution Analysis of 765 Patients from the US Gastric Cancer Collaborative. / Squires, Malcolm H.; Kooby, David A.; Poultsides, George A.; Weber, Sharon M.; Bloomston, Mark; Fields, Ryan C.; Pawlik, Timothy M.; Votanopoulos, Konstantinos I.; Schmidt, Carl R.; Ejaz, Aslam; Acher, Alexandra W.; Worhunsky, David J.; Saunders, Neil; Levine, Edward A.; Jin, Linda X.; Cho, Clifford S.; Winslow, Emily R.; Russell, Maria C.; Staley, Charles A.; Maithel, Shishir K.

In: Journal of the American College of Surgeons, Vol. 221, No. 3, 7935, 01.09.2015, p. 767-777.

Research output: Contribution to journalArticle

Squires, MH, Kooby, DA, Poultsides, GA, Weber, SM, Bloomston, M, Fields, RC, Pawlik, TM, Votanopoulos, KI, Schmidt, CR, Ejaz, A, Acher, AW, Worhunsky, DJ, Saunders, N, Levine, EA, Jin, LX, Cho, CS, Winslow, ER, Russell, MC, Staley, CA & Maithel, SK 2015, 'Effect of Perioperative Transfusion on Recurrence and Survival after Gastric Cancer Resection: A 7-Institution Analysis of 765 Patients from the US Gastric Cancer Collaborative', Journal of the American College of Surgeons, vol. 221, no. 3, 7935, pp. 767-777. https://doi.org/10.1016/j.jamcollsurg.2015.06.012
Squires, Malcolm H. ; Kooby, David A. ; Poultsides, George A. ; Weber, Sharon M. ; Bloomston, Mark ; Fields, Ryan C. ; Pawlik, Timothy M. ; Votanopoulos, Konstantinos I. ; Schmidt, Carl R. ; Ejaz, Aslam ; Acher, Alexandra W. ; Worhunsky, David J. ; Saunders, Neil ; Levine, Edward A. ; Jin, Linda X. ; Cho, Clifford S. ; Winslow, Emily R. ; Russell, Maria C. ; Staley, Charles A. ; Maithel, Shishir K. / Effect of Perioperative Transfusion on Recurrence and Survival after Gastric Cancer Resection : A 7-Institution Analysis of 765 Patients from the US Gastric Cancer Collaborative. In: Journal of the American College of Surgeons. 2015 ; Vol. 221, No. 3. pp. 767-777.
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title = "Effect of Perioperative Transfusion on Recurrence and Survival after Gastric Cancer Resection: A 7-Institution Analysis of 765 Patients from the US Gastric Cancer Collaborative",
abstract = "Background The prognostic effect of perioperative blood transfusion on recurrence and survival in patients undergoing resection of gastric adenocarcinoma (GAC) remains controversial. Study Design All patients who underwent resection for GAC from 2000 to 2012 at the 7 institutions of the US Gastric Cancer Collaborative were identified. The effect of transfusion on recurrence-free (RFS) and overall survival (OS) in the context of adverse clinicopathologic variables was examined by univariate and multivariate regression analyses. Results Of 965 patients, 765 underwent curative intent R0 resection. Median follow-up was 44 months; 30-day mortalities were excluded. Median estimated blood loss (EBL) was 200 mL, and 168 patients (22{\%}) received perioperative allogeneic blood transfusions. Transfused patients were less likely to receive adjuvant therapy (44{\%} vs 56{\%}; p = 0.01). Transfusion was associated with significantly decreased median RFS (13.5 vs 37.2 months, p <0.001). Median OS was similarly decreased in patients receiving transfusions (18.6 vs 49.8 months, p <0.001). On multivariate analysis, transfusion remained an independent risk factor for decreased RFS (hazard ratio [HR] 1.63; 95{\%} CI 1.13 to 2.37; p = 0.010) and decreased OS (HR 1.79; 95{\%} CI 1.21 to 2.67; p = 0.004), regardless of EBL or need for splenectomy. Timing (intraoperative vs postoperative) and volume of transfusion did not alter the negative prognostic effect of transfusion on survival. Conclusions Perioperative allogeneic blood transfusion is associated with decreased RFS and OS after resection of gastric cancer, independent of adverse clinicopathologic factors. This supports the judicious use of perioperative transfusion during resection of gastric cancer.",
author = "Squires, {Malcolm H.} and Kooby, {David A.} and Poultsides, {George A.} and Weber, {Sharon M.} and Mark Bloomston and Fields, {Ryan C.} and Pawlik, {Timothy M.} and Votanopoulos, {Konstantinos I.} and Schmidt, {Carl R.} and Aslam Ejaz and Acher, {Alexandra W.} and Worhunsky, {David J.} and Neil Saunders and Levine, {Edward A.} and Jin, {Linda X.} and Cho, {Clifford S.} and Winslow, {Emily R.} and Russell, {Maria C.} and Staley, {Charles A.} and Maithel, {Shishir K.}",
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TY - JOUR

T1 - Effect of Perioperative Transfusion on Recurrence and Survival after Gastric Cancer Resection

T2 - A 7-Institution Analysis of 765 Patients from the US Gastric Cancer Collaborative

AU - Squires, Malcolm H.

AU - Kooby, David A.

AU - Poultsides, George A.

AU - Weber, Sharon M.

AU - Bloomston, Mark

AU - Fields, Ryan C.

AU - Pawlik, Timothy M.

AU - Votanopoulos, Konstantinos I.

AU - Schmidt, Carl R.

AU - Ejaz, Aslam

AU - Acher, Alexandra W.

AU - Worhunsky, David J.

AU - Saunders, Neil

AU - Levine, Edward A.

AU - Jin, Linda X.

AU - Cho, Clifford S.

AU - Winslow, Emily R.

AU - Russell, Maria C.

AU - Staley, Charles A.

AU - Maithel, Shishir K.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Background The prognostic effect of perioperative blood transfusion on recurrence and survival in patients undergoing resection of gastric adenocarcinoma (GAC) remains controversial. Study Design All patients who underwent resection for GAC from 2000 to 2012 at the 7 institutions of the US Gastric Cancer Collaborative were identified. The effect of transfusion on recurrence-free (RFS) and overall survival (OS) in the context of adverse clinicopathologic variables was examined by univariate and multivariate regression analyses. Results Of 965 patients, 765 underwent curative intent R0 resection. Median follow-up was 44 months; 30-day mortalities were excluded. Median estimated blood loss (EBL) was 200 mL, and 168 patients (22%) received perioperative allogeneic blood transfusions. Transfused patients were less likely to receive adjuvant therapy (44% vs 56%; p = 0.01). Transfusion was associated with significantly decreased median RFS (13.5 vs 37.2 months, p <0.001). Median OS was similarly decreased in patients receiving transfusions (18.6 vs 49.8 months, p <0.001). On multivariate analysis, transfusion remained an independent risk factor for decreased RFS (hazard ratio [HR] 1.63; 95% CI 1.13 to 2.37; p = 0.010) and decreased OS (HR 1.79; 95% CI 1.21 to 2.67; p = 0.004), regardless of EBL or need for splenectomy. Timing (intraoperative vs postoperative) and volume of transfusion did not alter the negative prognostic effect of transfusion on survival. Conclusions Perioperative allogeneic blood transfusion is associated with decreased RFS and OS after resection of gastric cancer, independent of adverse clinicopathologic factors. This supports the judicious use of perioperative transfusion during resection of gastric cancer.

AB - Background The prognostic effect of perioperative blood transfusion on recurrence and survival in patients undergoing resection of gastric adenocarcinoma (GAC) remains controversial. Study Design All patients who underwent resection for GAC from 2000 to 2012 at the 7 institutions of the US Gastric Cancer Collaborative were identified. The effect of transfusion on recurrence-free (RFS) and overall survival (OS) in the context of adverse clinicopathologic variables was examined by univariate and multivariate regression analyses. Results Of 965 patients, 765 underwent curative intent R0 resection. Median follow-up was 44 months; 30-day mortalities were excluded. Median estimated blood loss (EBL) was 200 mL, and 168 patients (22%) received perioperative allogeneic blood transfusions. Transfused patients were less likely to receive adjuvant therapy (44% vs 56%; p = 0.01). Transfusion was associated with significantly decreased median RFS (13.5 vs 37.2 months, p <0.001). Median OS was similarly decreased in patients receiving transfusions (18.6 vs 49.8 months, p <0.001). On multivariate analysis, transfusion remained an independent risk factor for decreased RFS (hazard ratio [HR] 1.63; 95% CI 1.13 to 2.37; p = 0.010) and decreased OS (HR 1.79; 95% CI 1.21 to 2.67; p = 0.004), regardless of EBL or need for splenectomy. Timing (intraoperative vs postoperative) and volume of transfusion did not alter the negative prognostic effect of transfusion on survival. Conclusions Perioperative allogeneic blood transfusion is associated with decreased RFS and OS after resection of gastric cancer, independent of adverse clinicopathologic factors. This supports the judicious use of perioperative transfusion during resection of gastric cancer.

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