Transfusion as a Predictor of Recurrence and Survival in Head and Neck Cancer Surgery Patients

Objective: There is mixed evidence regarding the association of perioperative blood transfusion to disease recurrence and mortality in head and neck cancer patients. Moreover, few investigations have examined the effects of leukocyte-depleted (leukodepleted) red cell transfusion. The presented study was undertaken to ascertain whether perioperative transfusion of leukodepleted blood is associated with recurrence and survival in head and neck cancer surgery patients. Methods: The records of all patients having undergone head and neck surgery for malignant disease between October 1996 and October 2002 were reviewed. Hospital, blood bank, and cancer registry database records were reviewed and data were recorded onto a standardized computer spreadsheet. The primary outcome variable was the number of perioperatively transfused units of allogeneic leukodepleted blood. Multivariate analysis and Cox regression methods were employed. Results: Five hundred twenty patients met the criteria for inclusion in the study. Recurrence and mortality rates were significantly different between transfusion and no-transfusion groups, in favour of the no-transfusion group. In addition to age, T stage, and N stage, multivariate analysis revealed leukodepleted blood transfusion to be an independent predictor of both recurrence (odds ratio 1.6) and survival (hazard ratio 1.5). Conclusion: Perioperative transfusion of leukodepleted blood is associated with higher recurrence rates and decreased survival in head and neck cancer surgery.