The Associations between Perioperative Blood Transfusion and Long-Term Outcomes after Stomach Cancer Surgery
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Selection
2.2. Data Collection
2.3. Statistical Analysis
3. Results
3.1. Perioperative pRBC Transfusion and Disease-Free Survival
3.2. Perioperative pRBC Transfusion and Overall Survival
3.3. Predictors for Perioperative Transfusion
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Original Data | After IPTW | |||||
---|---|---|---|---|---|---|
Collected Variables | No Transfusion (n = 409) | Transfusion (n = 160) | SDD (%) | No Transfusion (n = 513) | Transfusion (n = 505) | SDD (%) |
Sex, male | 255 (62.3%) | 110 (68.8%) | 13.5 | 349 (65.3%) | 384 (74.8%) | 21.0 |
Age ≥ 70 years | 181 (44.3%) | 101 (63.1%) | 38.5 | 260 (48.7%) | 243 (47.3%) | 2.8 |
Body mass index, kg·m−2 | 23.87 ± 3.57 | 23.53 ± 3.91 | 9.2 | 23.71 ± 3.53 | 23.63 ± 3.52 | 2.2 |
Charlson comorbidity index | 4.7 ± 1.7 | 5.4 ± 1.8 | 43.9 | 4.8 ± 1.7 | 4.9 ± 1.8 | 1.5 |
Preoperative hemoglobin, g·dL−1 | 12.7 ±1.6 | 10.2 ± 2.1 | 131.1 | 12.3 ± 1.7 | 12.1 ± 2.5 | 9.6 |
Preoperative albumin, g·dL−1 | 4.1 ± 0.4 | 3.7 ± 0.5 | 84.7 | 4.0 ± 0.4 | 3.9 ± 0.4 | 18.8 |
CEA * | 1.02 ± 1.04 | 1.34 ± 1.15 | 28.4 | 1.10 ± 1.11 | 1.15 ± 1.00 | 5.0 |
CA19-9 * | 8.58 ± 0.39 | 8.65 ± 0.45 | 16.0 | 8.59 ± 0.39 | 8.65 ± 0.48 | 12.3 |
Anesthesia time, min * | 7.18 ± 1.36 | 8.39 ± 1.43 | 86.4 | 7.43 ± 1.37 | 7.66 ± 1.58 | 15.6 |
Blood loss during surgery, mL * | 3.06 ± 1.96 | 3.54 ± 2.44 | 21.6 | 3.24 ± 2.17 | 3.29 ± 1.88 | 2.3 |
Epidural analgesia | 171 (41.8%) | 70 (43.8%) | 3.9 | 226 (42.3%) | 252 (49.1%) | 13.8 |
Previous abdominal surgery | 62 (15.2%) | 24 (15.0%) | 0.4 | 86 (16.2%) | 95 (18.5%) | 6.1 |
Operation date | 11.9 | 9.1 | ||||
Before 2012 | 237 (57.9%) | 102 (63.8%) | 303 (56.8%) | 268 (52.2%) | ||
After 2012 | 172 (42.1%) | 58 (36.3%) | 231 (43.2%) | 245 (47.8%) | ||
Operation type | 31.3 | 10.3 | ||||
Total | 82 (20.0%) | 54 (33.8%) | 129 (24.2%) | 147 (28.7%) | ||
Subtotal | 327 (80.0%) | 106 (66.3%) | 405 (75.8%) | 366 (71.3%) | ||
Laparoscopic surgery | 120 (29.3%) | 15 (9.4%) | 52.2 | 130 (24.3%) | 92 (17.9%) | 15.7 |
Stage | 28.9 | 4.0 | ||||
I | 184 (45.0%) | 55 (34.4%) | 219 (41.0%) | 220 (42.9%) | ||
II | 113 (27.6%) | 35 (21.9%) | 141 (26.5%) | 137 (26.8%) | ||
III | 112 (27.4%) | 70 (43.8%) | 174 (32.6%) | 156 (30.3%) | ||
Tumor size ≥ 5 cm | 125 (30.6%) | 79 (49.4%) | 39.1 | 182 (34.2%) | 169 (32.9%) | 2.7 |
Histologic differentiation | 21.3 | 24.0 | ||||
Well to moderate | 179 (43.8%) | 87 (54.4%) | 241 (45.1%) | 292 (57.0%) | ||
Poor | 230 (56.2%) | 73 (45.6%) | 293 (54.9%) | 221 (43.0%) | ||
Lymphovascular invasion | 171 (41.8%) | 93 (58.1%) | 33.1 | 248 (46.4%) | 205 (39.9%) | 13.2 |
Residual tumor on surgical margin | 9 (2.2%) | 2 (1.3%) | 7.3 | 9 (1.8%) | 3 (0.5%) | 12.2 |
Adjunct chemotherapy | 144 (35.2%) | 69 (43.1%) | 16.3 | 204 (38.3%) | 215 (41.9%) | 7.3 |
Linear Effect | Non-Linear Effect | |||||
---|---|---|---|---|---|---|
Outcomes | Estimate | SE | p | Estimate | SE | p |
Recurrence-free survival | 0.149 | 0.038 | <0.001 | −0.035 | 0.013 | 0.008 |
Overall survival | 0.193 | 0.040 | <0.001 | −0.084 | 0.016 | <0.001 |
Selected Variables | HR | 95% CI | p |
---|---|---|---|
Packed red blood cell transfusion | 1.66 | 1.19~2.30 | 0.003 |
Sex (F vs. M) | 0.66 | 0.49~0.89 | 0.007 |
Body mass index | 0.95 | 0.91~0.99 | 0.007 |
Carlson comorbidity index | 1.17 | 1.08~1.26 | <0.001 |
Preoperative hemoglobin | 0.92 | 0.85~0.98 | 0.017 |
CEA * | 1.14 | 1.03~1.27 | 0.012 |
Operation date (after 2012 vs. before 2012) | 0.67 | 0.50~0.89 | 0.006 |
Surgery (subtotal vs. total) | 0.61 | 0.46~0.79 | <0.001 |
Stage | <0.001 | ||
II vs. I | 1.23 | 0.85~1.78 | 0.263 |
III vs. I | 2.21 | 1.60~3.06 | <0.001 |
Tumor size > 5 cm | 1.46 | 1.11~1.93 | 0.007 |
Residual tumor on surgical margin | 3.92 | 1.97~7.83 | <0.001 |
Selected Variables | HR | 95% CI | p |
---|---|---|---|
Packed red blood cell transfusion | 1.95 | 1.48~2.58 | <0.001 |
Body mass index | 0.94 | 0.90~0.97 | 0.001 |
Carlson comorbidity index | 1.25 | 1.16~1.35 | <0.001 |
CEA * | 1.16 | 1.04~1.29 | 0.009 |
Operation date (after 2012 vs. before 2012) | 0.67 | 0.50~0.90 | 0.008 |
Surgery (subtotal vs. total) | 0.64 | 0.48~0.84 | 0.001 |
Stage | <0.001 | ||
II vs. I | 1.20 | 0.83~1.73 | 0.339 |
III vs. I | 1.98 | 1.43~2.76 | <0.001 |
Tumor size > 5 cm | 1.43 | 1.08~1.89 | 0.011 |
Residual tumor on surgical margin | 3.31 | 1.60~6.85 | 0.001 |
Selected Variables | OR | 95% CI | p |
---|---|---|---|
Hemoglobin | 0.43 | 0.37~0.51 | <0.001 |
Blood loss during surgery * | 2.52 | 2.02~3.15 | <0.001 |
Carlson comorbidity index | 1.21 | 1.05~1.40 | 0.010 |
Body mass index | 0.93 | 0.87~1.00 | 0.043 |
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Hsu, F.-K.; Chang, W.-K.; Lin, K.-J.; Liu, C.-Y.; Fang, W.-L.; Chang, K.-Y. The Associations between Perioperative Blood Transfusion and Long-Term Outcomes after Stomach Cancer Surgery. Cancers 2021, 13, 5438. https://doi.org/10.3390/cancers13215438
Hsu F-K, Chang W-K, Lin K-J, Liu C-Y, Fang W-L, Chang K-Y. The Associations between Perioperative Blood Transfusion and Long-Term Outcomes after Stomach Cancer Surgery. Cancers. 2021; 13(21):5438. https://doi.org/10.3390/cancers13215438
Chicago/Turabian StyleHsu, Fu-Kai, Wen-Kuei Chang, Kuan-Ju Lin, Chun-Yu Liu, Wen-Liang Fang, and Kuang-Yi Chang. 2021. "The Associations between Perioperative Blood Transfusion and Long-Term Outcomes after Stomach Cancer Surgery" Cancers 13, no. 21: 5438. https://doi.org/10.3390/cancers13215438