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Transfusion of red blood cells does not impact progression‐free and overall survival after surgery for ovarian cancer
Author(s) -
Hunsicker Oliver,
Gericke Sara,
Graw Jan Adriaan,
Krannich Alexander,
Boemke Willehad,
Meyer Oliver,
Braicu Ioana,
Spies Claudia,
Sehouli Jalid,
Pruß Axel,
Feldheiser Aarne
Publication year - 2019
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.15552
Subject(s) - medicine , perioperative , hazard ratio , proportional hazards model , blood transfusion , retrospective cohort study , cancer , ovarian cancer , propensity score matching , prospective cohort study , surgery , clinical endpoint , confidence interval , randomized controlled trial
BACKGROUND Allogeneic red blood cells (RBCs) have the potential to impact the immunosurveillance of the recipient and may therefore increase the risk of recurrence after cancer surgery. In this article the relationship between perioperative RBC transfusion and the risk of recurrence after ovarian cancer surgery is examined. STUDY DESIGN AND METHODS This is a retrospective cohort analysis of a prospective database of patients who underwent surgery due to primary ovarian cancer between 2006 and 2014 and who had no residual disease after surgery. Patients who did and did not receive perioperative RBC transfusion were compared. The primary endpoint was progression‐free survival (PFS). Propensity score matching (PSM) and Cox proportional hazards regression (CPH) was used to control for between‐group differences of prognostic determinants. RESULTS A total of 529 patients with a median follow‐up of 51.4 months (95% CI, 46.1‐56.5) were eligible for analysis. Of those, 408 patients (77.1%) received allogeneic, leukoreduced RBCs with a median of 4 units (IQR, 2‐6) per patient. There was a strong selection bias of prognostic determinants between patients with and without transfusion. In unadjusted analysis, transfusion of RBCs was associated with an increased risk of cancer recurrence (hazard ratio [HR] of PFS 2.71 [95% CI, 1.94‐3.77], p < 0.001). After bias reduction, transfusion of RBCs was no longer associated with an increased risk of cancer recurrence, neither in PSM‐adjusted (HR 1.03 [95% CI, 0.59‐1.80], p = 0.91), nor in multivariable CPH‐adjusted analysis (HR 1.26 [95% CI, 0.85‐1.86], p = 0.23). CONCLUSION Perioperative transfusion of RBCs did not increase the risk of recurrence after ovarian cancer surgery.