Perioperative blood transfusion has a dose-dependent relationship with disease recurrence and survival in patients with non-small cell lung cancer

被引:31
作者
Latif, M. Jawad [1 ]
Tan, Kay See [2 ]
Molena, Daniela [1 ]
Huang, James [1 ]
Bott, Matthew J. [1 ]
Park, Bernard J. [1 ]
Adusumilli, Prasad S. [1 ]
Rusch, Valerie W. [1 ]
Bains, Manjit S. [1 ]
Downey, Robert J. [1 ]
Jones, David R. [1 ]
Isbell, James M. [1 ]
机构
[1] Mem Sloan Kettering Canc Ctr, Dept Surg, Thorac Surg Serv, 1275 York Ave, New York, NY 10065 USA
[2] Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, New York, NY 10065 USA
基金
美国国家卫生研究院;
关键词
transfusion; lung cancer; lobectomy; segmentectomy; survival; propensity-score matching; recurrence; LIMITED RESECTION; SURGERY; PROGNOSIS; LOBECTOMY; IMPACT;
D O I
10.1016/j.jtcvs.2018.12.109
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:2469 / +
页数:19
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