Blood transfusion and survival following surgery for prostatic carcinoma

McClinton, Samuel; Moffat, L. E. F.; Scott, Stacy N.; Urbaniak, S. J.; Kerridge, D. F.

doi:10.1002/bjs.1800770208

Cited by 52 publications

(33 citation statements)

References 20 publications

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“…In addition, there is the potential down-regulation of host cellular immune function with transfusion (Blumberg and Heal, 1990). A number of retrospective reviews have documented adverse outcomes (inferior overall and disease-free survival) in patients receiving blood transfusions for a variety of malignancies including colon/rectum, lung, prostate, uterine cervix, breast and soft tissues (Rosenberg et al, 1985;Tartter et al, 1985;Arnoux et al, 1988;Blumberg et al, 1988;Corman et al, 1988;Heal et al, 1988;Moores et al, 1989;Wobbes et al, 1989;Little et al, 1990;McClinton et al, 1990;Casper et al, 1991). Thus, although transfusion can improve tissue oxygenation and potentially enhance the effectiveness of RT, any radiobiological gain might be mitigated by the adverse effects of transfusion on tumour immunosurveillance (Levine and Vijayakumar, 1993).…”

Section: Discussionmentioning

confidence: 99%

Effect of subcutaneous recombinant human erythropoetin in cancer patients receiving radiotherapy: final report of a randomized, open-labelled, phase II trial

Sweeney

Nicolae²,

Ignacio³

et al. 1998

Br J Cancer

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Summary The purpose of this study was to determine the safety, efficacy and impact on quality of life of recombinant human erythropoietin (r-HuEPO) for cancer patients undergoing radiotherapy (RT). An open-labelled randomized design was used, with patients randomized to either treatment or control arms. Patients in the treatment arm received r-HuEPO given by subcutaneous injection at a dose of 200 units kg-' day-' plus oral iron supplements (ferrous sulphate 325 mg p.o. t.i.d.). Entry was restricted to patients with carcinoma of the lung, uterine cervix, prostate or breast who presented for RT with anaemia parameters reflective of 'the anaemia of chronic disease'. Radiotherapy policies (portals, doses, fraction size, etc.) were determined by the site and stage of disease. Complete blood counts (CBCs) were obtained weekly. The target level of haemoglobin was 15 g dl-1 for men and 14 g dl-1 for women. Quality of life (QOL) was assessed weekly by using an analogue scale to judge energy, activities of daily living and overall quality of life. Forty-eight patients were entered in the study, 24 in the treatment arm and 24 in the control arm. The prerandomization demographic characteristics and mean laboratory values were comparable in both arms. The mean haemoglobin at completion was 13.6 g dl-1 for r-HuEPO-treated patients compared with 11.0 g dl-1 for control subjects (P= 0.0012). Patients who received r-HuEPO demonstrated a mean weekly haemoglobin increase of 0.41 g dl-1 compared with a decrease in mean haemoglobin level in controls for 6 of the 7 weeks of the study (mean weekly decrease of 0.073 g dl-'). Target levels of haemoglobin were achieved by 41.6% of r-HuEPO-treated patients compared with none of the control subjects. The mean platelet count declined in both arms of the study with RT but the decline from pretreatment was less rapid in r-HuEPO-treated patients (11.2% decrease) compared with controls (26.3% decrease) and was statistically significant during weeks 4-6. Toxicity was minor with only mild irritation at the injection site. Mean quality of life end points were superior in the treatment arm but not statistically significant. r-HuEPO had a beneficial effect on weekly haemoglobin levels in patients undergoing RT with response rates similar to other studies. There was also a less rapid decline in weekly platelet counts in r-HuEPO-treated patients compared with control subjects. Further studies are needed to address the optimum dose and scheduling as well as the impact of r-HuEPO on clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Effect of subcutaneous recombinant human erythropoetin in cancer patients receiving radiotherapy: final report of a randomized, open-labelled, phase II trial

Sweeney

Nicolae²,

Ignacio³

et al. 1998

Br J Cancer

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“…2 This, in turn, may be attributable to the reduction in surgical stress response that regional anesthesia provides by blocking nociceptive afferent inputs. 3 Allogeneic blood transfusion is known to decrease cancer survival, 4,5 and regional anesthesia reduces the risk of such transfusions. Our group previously demonstrated that the use of a combined general/epidural hypotensive anesthesia technique during radical prostate surgery resulted in less need for allogeneic blood.…”

Section: Résumémentioning

confidence: 99%

Epidural anesthesia and cancer recurrence rates after radical prostatectomy

Tsui

Rashiq

Schopflocher

et al. 2009

Can J Anesth/J Can Anesth

167

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Purpose To determine the effect of adjunctive epidural local anesthetic and opioid infusion on disease recurrence following radical prostatectomy for adenocarcinoma under general anesthesia. Methods This article describes a secondary analysis of subjects undergoing radical prostatectomy who had participated previously in a randomized controlled trial evaluating pain control, blood loss, and the need for perioperative allogeneic blood transfusion. The patients were randomly allocated to receive either general anesthesia alone (control group; n = 50) or combined general/ epidural anesthesia (study group; n = 49). A long-term follow-up chart review was undertaken to determine clinically evident or biochemical (Prostate Specific Antigen [0.2 ng Á mL -1 ) recurrence of prostate cancer. Comparison by group was undertaken using survival analysis.Results Median disease-free survival for the study as a whole was 1644 days, and the longest recorded survival was 3403 days. Biochemical recurrence of prostate cancer was observed in 11/49 study subjects and 17/50 control subjects. There was one death from prostate cancer in each group and a total of five deaths in the study group and six deaths in the control group. The hazard ratio for recurrence in the study group compared with the control group was 1.33 (95% confidence intervals 0.64-2.77; P = 0.44 by log-rank test). Conclusion No difference was observed between the epidural and control groups in disease-free survival at a median follow-up time of 4.5 years. There is a need for large randomized controlled trials to determine the ability of epidural analgesia to alter disease recurrence rates following radical prostatectomy. RésuméObjectif De´terminer l'effet d'une the´rapie adjuvante d'anesthe´sique local pe´ridural et perfusion d'opioı¨des sur la re´currence de la maladie apre`s une prostatectomie radicale pour ade´nocarcinome sous anesthe´sie ge´ne´rale. Méthode Cet article de´crit une analyse secondaire de patients ayant subi une prostatectomie radicale, lesquels avaient pre´ce´demment participe´a`une e´tude randomise´e contrôle´e e´valuant le contrôle de la douleur, les pertes sanguines et le besoin de transfusions sanguines alloge`nes en pe´riode pe´riope´ratoire. Les patients ont e´te´randomise´s a`recevoir soit une anesthe´sie ge´ne´rale seule (groupe te´moin; n = 50) ou une combinaison d'anesthe´sie ge´ne´rale et pe´ridurale (groupe a`l'e´tude; n = 49). Une re´vision des dossiers de suivi a`long terme a e´te´entreprise afin de

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“…A large bleed seemed to be associated with a doubled risk of general progression and death from prostatic cancer as compared to those with a small bleed, but this risk estimate was only close to reaching statistical significance. This finding offers an alternative explanation of why blood transfusions seem to promote death in prostatic cancer [17]. In the present study, a large blood loss was associated with an increased risk of death although only one of the patients received erythrocytes.…”

Section: Discussionmentioning

confidence: 51%

Operative Course of Transurethral Resection of the Prostate and Progression of Prostate Cancer

Trygg¹,

Ekengren²,

Farahmand

et al. 1998

Urol Int

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Surgery has the potential to disseminate cancer cells, and we therefore hypothesized that extensive transurethral resections of the prostate (TURP) would be followed by a worse prognosis than minor ones. For this purpose, the association between the extent of surgery, disease progression, and mortality was studied in 138 patients with prostatic cancer who had undergone TURP. The results show that a large bleed (≥275 ml) indicated a slightly increased relative risk of general progression of the cancer (relative risk (RR) = 1.9, 95% confidence interval (CI) = 0.9–4.1) and death (RR = 1.5, CI = 0.6–3.3). Other parameters of extensive surgery, such as the operating time and fluid absorption, were not associated with increased risk. Patients with a medical disease, however, such as hypertension and congestive heart failure, had a significantly higher relative risk of general progression (RR = 2.7, CI = 1.2–6.1) and death from prostatic cancer (RR = 4.6, CI = 2.0–10.7) in addition to an increased relative risk of death from other causes (RR = 3.7, CI = 1.3–10.5). We conclude that concurrent medical disease, but not an extensive TURP, worsened the prognosis of patients with prostatic cancer who underwent TURP.

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Blood transfusion and survival following surgery for prostatic carcinoma

Cited by 52 publications

References 20 publications

Effect of subcutaneous recombinant human erythropoetin in cancer patients receiving radiotherapy: final report of a randomized, open-labelled, phase II trial

Effect of subcutaneous recombinant human erythropoetin in cancer patients receiving radiotherapy: final report of a randomized, open-labelled, phase II trial

Epidural anesthesia and cancer recurrence rates after radical prostatectomy

Operative Course of Transurethral Resection of the Prostate and Progression of Prostate Cancer

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