Blood Transfusion and Other Risk Factors for Recurrence of Cancer of the Head and Neck

Abstract

To determine whether perioperative blood transfusion affected the recurrence rate of squamous cell cancer of the head and neck, we performed a retrospective study of all patients with stage III and IV disease treated surgically at the University of North Carolina, Chapel Hill, between 1983 and 1986. Those who recurred were compared with those who did not in regard to 16 prognostic variables, including whether or not they had received a perioperative blood transfusion. Analyzing each variable separately, five were significantly related to recurrence. These were (1) surgical margin status, (2) stage, (3) presence of pathologically positive nodes, (4) blood transfusion status, and (5) type of treatment. However, because several of these variables were clearly interrelated, the same data were subjected to a multivariate regression analysis specifically designed to identify significant prognostic variables independent of their association with other variables. By this analysis, only margin status and the presence or absence of a blood transfusion were statistically significant predictors of recurrence.

The influence of allogenic blood transfusion in patients having free-flap primary surgery for oral and oropharyngeal squamous cell carcinoma

“…To date, clinical trials are inconclusive as to whether tumour recurrence rate is higher after transfusion in head and neck cancer (Jones and Weissler, 1990;Sturgis et al, 1997). Our study suggests that the local and systemic cancer recurrence rate is higher in those patients who were transfused with 3 or more units of blood.…”

“…In head and neck cancer, the effect of allogenic blood transfusion has been reported on relatively small numbers of patients with conflicting results (Table 1) (von Doersten et al, 1992;Woolley et al, 1992;Sturgis et al, 1997;Vamvakas and Blajchman, 2001;Taniguchi and Okura, 2003). Some authors have reported deleterious effects of blood transfusion (Jones and Weissler, 1990;Woolley et al, 1992;Taniguchi and Okura, 2003), while others could not confirm transfusion as an independent predictive factor in multivariate analysis (von Doersten et al, 1992;Schuller et al, 1994). A recent paper by Taniguchi and Okura (2003), specific to oral and oropharyngeal cancer, only showed the outcomes were worse with 3 or more units.…”

Use of a leucocyte filter to remove tumour cells from intra‐operative cell salvage blood

“…In contrast, there is evidence that allogeneic transfusion is independently associated with an increased rate of both postoperative infection [5] and disease recurrence [4]. In 1992 Wooley and colleagues [3] studied 143 patients with head and neck squamous carcinoma and showed that the odds ratio for recurrence at 5 years for patients receiving allogeneic blood was 3.2 (95% CI 1.5-6.9, p < 0.004).…”

“…Patients benefit by avoiding the risks of homologous (allogeneic) blood transfusion [1] and the NHS benefits from conserving the supply of blood and, potentially, reducing costs [2]. Allogeneic transfusion has been shown to be associated with both tumour recurrence [3,4] and postoperative infections [5], and these associations are not seen with autologous transfusion [6][7][8][9][10]. In the UK pre-operative autologous donation and acute normovolaemic haemodilution are not currently recommended by the National Blood Service except in exceptional circumstances [11].…”

Influence of surgical treatment and radiotherapy of the advanced intraoral cancers on complete blood count, body mass index, liver enzymes and leukocyte CD64 expression

“…Blood transfusion is known to have some immunomodulatory effect 30 that might predict outcome. 31,32 Studies regarding anaemia prior to RT have sown that anaemic patients have lower locoregional control and lower overall survival. 27,[33][34][35] Proposed levels of Hb prior to RT is 120 g/l 36 , which was also the level of haemoglobin in our study after surgery.…”