Prognostic Impact Analyses Of Perioperative Blood Transfusion On Gastric Cancer

Objective Gastric cancer is the fourth common carcinoma and the second major cause of cancer-related death. Due to acute / chronic hemorrhage, tumor consumption, and other factors, gastric cancer patients often experience varying degree of anemia. Allogenic blood transfusion is the major treatment for cancer-related anemia. Perioperative blood transfusion has been controversial as it may reduce the survival. Current studies suggest perioperative blood transfusion is an independent prognostic factors, while some studies stand against the result. Therefore, in this study, a retrospective prognostic impact analyses of perioperative blood transfusion on gastric cancer was performed to provide the basis for applications and treatments on gastric cancer patients.Method Clinical data were collected retrospectively from 281 consecutive patients who underwent curative gastric resection in Shanghai Jiaotong University School of Medicine Affiliated Ruijin Hospital gastric cancer ward in the period from 2008 to 2009. The prognostic impact of blood transfusion on patient survival was evaluated. Subgroup analysis was performed according to units of blood transfused and timing of transfusion.Result 281 patients include 183 male and 98 female, with a median age of 60.Five year survival rate of patients without perioperative blood transfusion is 72.7%, while patients with perioperative blood transfusion is 45.8%.The significant difference suggests gastric cancer patients who received perioperative blood transfusion has poor prognosis. Subgroup analyses were performed based on pathological TNM staging, transfusion period, and unit of blood transfused. Five year survival rate of patients without blood transfusion is 96.6% whilepatients with blood transfusion is 93.8% in stage I; without blood transfusion is 70.7% while with blood transfusion is 58.8% in stage II; without blood transfusion is 44.3% while with blood transfusion is 26% in stage IIII. The differences were statistically analyzed, and the result suggests perioperative blood transfusion is an independent prognostic risk factor for stage II, and stage III(Advanced stage) gastric cancer. Five years survival rate for preoperative blood transfusion is 60.0%, for intraoperative blood transfusion is 33.3%, and for postoperative blood transfusion is 56.3%. The significant difference suggests intraoperative blood transfusion leads to poor prognosis, while the units of blood transfused has no correlation with prognosis. Multivariate analyses revel advance TNM stage( stage II, stage III), preoperative low albumin, preoperative anemia, serosal invasion(T4), lymph node metastasis, tumor size greater than 5cm, and pathological low differentiated are independent risk factors of prognosis.Conclusion The result indicates perioperative blood transfusion is an independent risk factors of prognosis in patients with advanced gastric cancer regardless the units of blood transfused. Perioperative blood transfusion especially intraoperative blood transfusion should be avoided.