Impact Of Perioperative Allogeneic Red Blood Cell Transfusion On The Prognosis Of Patients With Epithelial Ovarian Cancer

Background:The standard treatment of ovarian cancer is surgery.The goal of surgery is to achieve satisfactory cytoreductive surgery.In order to achieve this goal,the operation is often wide range,trauma,time-consuming,intraoperative blood loss is large.In order to ensure the safety of surgery and strengthen the recovery of patients,patients with ovarian cancer received allogeneic red blood cell infusion during perioperative period.Allogeneic red blood cell infusion can induce a series of immune reactions and inhibit the immune system of tumor patients,that is,blood transfusion related immune regulation.This immunosuppressive state may lead to the occurrence of new metastases,promote tumor metastasis and recurrence,reduce the survival rate of cancer patients and increase the risk of recurrence.However,whether it has a negative impact on the prognosis of patients with epithelial ovarian cancer is still controversial,and there is a lack of relevant research in China.According to the statistics of the American College of physicians(ACP),the transfusion of red blood cells in 67%of cancer patients is unreasonable.Whether the use of restrictive transfusion strategy can have a positive impact on the prognosis of patients with epithelial ovarian cancer by reducing the transfusion rate remains to be explored.Method:The clinical data of patients with epithelial ovarian cancer who treated in Qilu Hospital of Shandong University from January 2014 to December 2016 were collected.It included demographic information,initial diagnosis,ASA classification,operation process(operation time,degree of tumor reduction,ascites volume,blood loss),pathological characteristics(histological type,tumor size,tumor differentiation and FIGO stage),pre-treatment hemoglobin level,pre-operative serum CA125 level,and perioperative red blood cell infusion volume.Patients were divided into transfusion group and non-transfusion group according to whether they received allogeneic red blood cell transfusion in perioperative period.Mann Whitney rank sum test and chi square test were used to analyze the clinical data between the blood transfusion group and the non-transfusion group.The significance was set as P<0.05.Kaplan Meier method was used to calculate the 3-year overall survival rate and 3-year disease-free survival rate of each subgroup,and the survival curve of each subgroup was drawn.Log rank test was used for univariate analysis to analyze whether blood transfusion and other variables were related to epithelial ovarian cancer Cox proportional hazard regression model was used to further analyze whether perioperative red blood cell infusion was an independent risk factor for the prognosis of patients with epithelial ovarian cancer,and the significance was set as P<0.05.Result:Total of 314 patients with epithelial ovarian cancer were included in this study.Among them,121 patients(38.5%)received perioperative allogeneic red blood cell infusion.Compared with patients without blood transfusion,patients in blood transfusion group had higher preoperative CA-125 level(1532 vs 829u/ml,P<0.05),more intraoperative blood loss(853 vs 308ml,P<0.05),more ascites(1243 vs 604ml,P<0.05),higher incidence of anemia(36%vs 16%,P<0.05)and longer hospital stay(17.5± 5.81 vs 16.1 ± 6,P=0.007).The 3-year overall survival rate and 3-year disease-free survival rate of blood transfusion group were significantly lower than those of non-blood transfusion group(48.8%vs 70.5%,15.9%vs 42.4%,P<0.05).After Cox regression risk model adjustment analysis,the effect of perioperative allogeneic red blood cell infusion on the prognosis of patients with epithelial ovarian cancer is still significant.The risk of death was 1.5 times higher in patients without blood transfusion(HR=1.587,95%CI 1.120-2.250),and the risk of recurrence was 1.6 times higher in patients without blood transfusion(HR=1.629,95%CI 1.216-2.182).Average hemoglobin level at the time of blood transfusion was 86.9±13.2g/l.The hemoglobin level of 89.3%(108 cases)patients at the time of blood transfusion was higher than the restrictive blood transfusion threshold of 70g/L in the 2016 American blood bank association blood transfusion guidelines.Conclusion:Perioperative allogeneic red blood cell transfusion is an independent prognostic factor for patients with epithelial ovarian cancer,which will have an adverse impact on the prognosis of patients.Blood transfusion can also lead to prolonged hospital stay and increased costs.In clinical work,more than half of the blood transfusion failed to adhere to the blood transfusion guidelines based on strong evidence(revised by AABB in 2016),and the restrictive blood transfusion threshold was used to guide clinical practice Blood transfusion,reducing the rate of blood transfusion,will have a positive impact on the prognosis of patients with epithelial ovarian.