Influence of blood transfusions and preoperative anemia on long-term survival in patients operated for non-small cell lung cancer

Παναγόπουλος, Νικόλαος; Καρακάντζα, Μαρίνα; Koletsis, Efstratios; Apostolakis, Efstratios; Sakellaropoulos, George; Filos, Kriton S.; Theodori, E.; Dougenis, Dimitrios

doi:10.1016/j.lungcan.2008.02.025

Cited by 34 publications

(30 citation statements)

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“…In various solid tumors, the significance of preoperative anemia has been demonstrated in patients who underwent surgical treatment. In studies on patients with non-small cell lung cancer who were treated with surgery, preoperative anemia was reported as an independent negative prognostic factor [16,17]. …”

Section: Discussionmentioning

confidence: 99%

“…Several biological factors can explain how anemia can lead to poor outcomes. Evidence from studies on cancer of the lung [16,17], head and neck [12], and ovarian cancer [4] has demonstrated the adverse prognostic impact of tumor hypoxia within the tumor bed, structural and functional abnormalities result in haphazard architecture hindering oxygen diffusion from vessels to individual cells and causing hypoxia. Low oxygen tension within cancer cells initiates biological behaviors that lead to formation of a more aggressive phenotype and induction of angiogenesis.…”

Section: Discussionmentioning

confidence: 99%

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An association between preoperative anemia and poor prognostic factors and decreased survival in early stage cervical cancer patients

et al. 2014

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ObjectiveTo evaluate correlation of preoperative anemia with clinical outcomes in patients with early stage cervical cancer who were treated with radical hysterectomy and lymph node dissection.MethodsPatients who underwent radical hysterectomy and lymph node dissection for cervical cancer from January 2001 to February 2012 were included in this study. Clinicopatholgoical factors included in univariate and multivariate analysis were age, tumor histology, FIGO (International Federation of Gyneocology and Obstetrics) stage, preoperative hemoglobin, depth of invasion, tumor size, parametrial involvement, resection margin, and lymph node status.ResultsA total of 387 patients were retrospectively analyzed in this study; 141 patients (36.4%) had preoperative anemia (hemoglobin <12 g/dL) and 16 out of 141 patients (11.3%) received blood transfusion for correction of preoperative anemia. Patients with preoperative anemia showed significant association with age <50 years, more advanced stage, non-squamous cell carcinoma histology, larger tumor size, deeper stromal invasion, and lymph node metastasis (P<0.05). Both relapse-free survival and overall survival were worse in patients with preoperative anemia in univariate analysis. In multivariate analysis, overall survival was worse in patients with preoperative anemia, but relapse-free survival was not associated with preoperative anemia. In the intergroup analysis of anemic patients for the effect of preoperative blood transfusion, preoperative anemia correction did not affect survival.ConclusionPreoperative anemia was not an independent prognostic factor for survival in patients with early cervical cancer. However, it was associated with poor prognostic factors. Further study in large population is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An association between preoperative anemia and poor prognostic factors and decreased survival in early stage cervical cancer patients

et al. 2014

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“…Panagopoulos et al . suggested that pRBC transfusions, regardless of whether they are leukoreduced, explains the association between ABT and poor outcomes [32] . Another limitation is that we did not define the triggers of ABT, intraoperative blood loss or evaluated the impact of ABT timing (intraoperative or postoperative) on survival.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Anemia, Blood Transfusion, and Neutrophil-to-Lymphocyte Ratio in Patients with Stage I Non–Small Cell Lung Cancer

Cata

Gutiérrez

Mehran

et al. 2016

Cancer Cell Microenviron

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Perioperative and postoperative blood transfusions (BT), anemia and inflammation are associated with poor survivals in patients with non-small cell lung cancer (NSCLC). This study investigated the impact of perioperative BT on the survival of patients with NSCLC taking into account their preoperative inflammatory status and the presence of anemia. Demographic, perioperative, and survival data for 861 patients with stage I NSCLC was collected retrospectively. The primary endpoints of interest were recurrence-free (RFS) and overall survival (OS). Before and after propensity score matching, univariate and multivariable Cox proportional hazards models were used to evaluate the association between covariates and survival. A neutrophil-to-lymphocyte ratio (NLR) < 5 (hazard ratio [HR]: 0.58, 95% CI: 0.38-0.87; p = 0.009) and normal Hb concentration (HR: 0.72, 95% CI: 0.72; p = 0.022) were independently associated with longer RFS. The administration of blood perioperatively was associated with a trend towards worse RFS (HR: 0.69, 95% CI: 0.47-1.02; p = 0.066). The multivariate analysis also revealed that an NLR < 5 (HR: 0.48, 95% CI: 0.3-0.76; p = 0.001) and the absence of BT (HR: 0.63, 95% CI: 0.4-0.98; p = 0.04) were significantly associated with lower mortality risk. The propensity score matching analysis did not confirm the association between BT and poor RFS (HR: 0.63, 95% CI: 0.35-1.1; p = 0.108) and OS (HR: 0.52, 95% CI: 0.26-1.04; p = 0.06). Inflammation and anemia are common finding in patients with stage 1 NSCLC. After adjusting for these two important confounders, this study confirms that previous reports demonstrating an association between BT and poor survival after NSCLC surgery.

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“…Indeed, ESAs have been associated with an increased risk of mortality, [78][79][80][81] particularly in trials with a Hb target threshold of 13 g/dL. 78 Despite early reports of a survival benefit, recent large meta-analyses comparing ESAs with placebo or standard-of-care in cancer patients, have associated their use with an increased risk of mortality, [82][83][84][85] particularly, as previously noted in trials with a Hb target threshold of 13 g/dL. 82 Based on these concerns the US Food and Drug Administration (FDA), in 2007, issued a black box warning for recombinant epoetins and ruled that ESA therapy should be suspended when Hb levels exceed 12 g/dL.…”

Section: Treatment Of Anaemia In Elderly Patients Receiving Chemotherapymentioning

confidence: 99%

“…82 Caution is also necessary in patients with Hb levels< 12 g/dL since the risks of shortened survival and disease progression have not been discounted when using ESAs at these levels. 83 Notably however, the mortality risks reported for ESAs to-date 79,80 have been lower than those associated with transfusions alone, 84,85 though this has not been investigated in a randomised comparative study and uncertainties still remain regarding the risk of mortality with either therapy. In particular, data on risks of transfusions are often retrospective and do not rule out the fact that transfused patients usually have more comorbidities or more active disease, thereby explaining the reported negative impact on outcome.…”

Section: Treatment Of Anaemia In Elderly Patients Receiving Chemotherapymentioning

confidence: 99%

Haematological support, fatigue and elderly patients

Aapro

Rüffer

Früehauf

2012

Journal of Geriatric Oncology

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Influence of blood transfusions and preoperative anemia on long-term survival in patients operated for non-small cell lung cancer

Cited by 34 publications

References 34 publications

An association between preoperative anemia and poor prognostic factors and decreased survival in early stage cervical cancer patients

An association between preoperative anemia and poor prognostic factors and decreased survival in early stage cervical cancer patients

Preoperative Anemia, Blood Transfusion, and Neutrophil-to-Lymphocyte Ratio in Patients with Stage I Non–Small Cell Lung Cancer

Haematological support, fatigue and elderly patients

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