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 histological 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 (CIR), 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 [25 th -75 th percentile, 3.98-11.8]). There was no difference in OS, DFS, or CIR between patients receiving no transfusion and those receiving single-unit transfusion (P>0.05). However, a dose-response relationship was observed, demonstrating worse OS (overall P<0.001), DFS (overall P<0.001), and recurrence (overall P=0.010) with increasing units of blood transfused.

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