Association of preoperative anemia and perioperative allogenic red blood cell transfusion with oncologic outcomes in patients with nonmetastatic colorectal cancer

Abstract

Background: We investigated whether preoperative anemia and perioperative blood transfusion (pbt) are associated with overall survival and recurrence-free survival in patients with nonmetastatic colorectal cancer.

Methods: From 1 January 2009 to 31 December 2014, 1003 patients with primary colorectal cancer were enrolled in the study. Perioperative clinical and oncologic outcomes were analyzed based on the presence of preoperative anemia and pbt.

Results: Preoperative anemia was found in 468 patients (46.7%). In the anemia and no-anemia groups, pbt was performed in 44% and 15% of patients respectively. Independent predictors for pbt were preoperative anemia, higher American Society of Anesthesiologists score, laparotomy, lengthy operative time, advanced TNM stage, T4 stage, and 30-day morbidity. The use of pbt, but not preoperative anemia, was found to be an independent adverse prognostic factor for overall survival. In terms of recurrence-free survival, the presence of preoperative anemia was similarly not a significant prognostic factor, but the use of pbt was an independent factor for an unfavourable prognosis.

Conclusions: The use of pbt, but not preoperative anemia, was independently associated with worse overall and recurrence-free survival in nonmetastatic colorectal cancer. For better oncologic outcomes, our findings indicate a need to reduce the use of blood transfusion during the perioperative period.

Keywords: Colonic neoplasms; anemia; blood transfusions; rectal neoplasms; survival.

FIGURE 1

Overall survival by the Kaplan–Meier method. (A) The 3-year overall survival rate was significantly worse in the anemia group than in the no-anemia group (81.5% vs. 87.5%, p = 0.002). (B) The 3-year overall survival rate was worse for patients who received a perioperative allogenic red blood cell transfusion than for those who did not (76.9% vs. 88.2%, p < 0.001). (C) Taking preoperative anemia and perioperative transfusion into consideration, the 3-year overall survival rates were 76.1%, 78.4%, 86.2%, and 89.4% in the anemia and transfusion, the no-anemia and transfusion, the anemia and no-transfusion, and the no-anemia and no-transfusion groups respectively (p < 0.001).

FIGURE 2

Recurrence-free survival by the Kaplan–Meier method. (A) The presence of preoperative anemia did not lead to a significantly worse recurrence-free survival rate (75.0% vs. 80.6%, p = 0.059). (B) Receiving a perioperative allogenic red blood cell transfusion resulted in significantly worse recurrence-free survival (70.9% vs. 80.9%, p < 0.001). (C) The overall 3-year recurrence-free survival rates were 71.3%, 76.7%, 78.6%, and 82.4% in the no-anemia and transfusion, the anemia and transfusion, the anemia and no-transfusion, and the no-anemia and no-transfusion groups respectively (p < 0.001).