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Perioperative transfusion and long-term mortality after cardiac surgery: a meta-analysis. Gen Thorac Cardiovasc Surg 2023; 71:323-330. [PMID: 36884106 DOI: 10.1007/s11748-023-01923-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES Cardiac surgical procedures are associated with a high incidence of periprocedural blood loss and blood transfusion. Although both may be associated with a range of postoperative complications there is disagreement on the impact of blood transfusion on long-term mortality. This study aims to provide a comprehensive review of the published outcomes of perioperative blood transfusion, examined as a whole and by index procedure. METHODS A systematic review of perioperative blood transfusion cardiac surgical patients was conducted. Outcomes related to blood transfusion were analysed in a meta-analysis and aggregate survival data were derived to examine long-term survival. RESULTS Thirty-nine studies with 180,074 patients were identified, the majority (61.2%) undergoing coronary artery bypass surgery. Perioperative blood transfusions were noted in 42.2% of patients and was associated with significantly higher early mortality (OR 3.87, p < 0.001). After a median of 6.4 years (range 1-15), mortality remained significantly higher for those who received a perioperative transfusion (OR 2.01, p < 0.001). Pooled hazard ratio for long-term mortality similar for patients who underwent coronary surgery compared to isolated valve surgery. Differences in long-term mortality for all comers remained true when corrected for early mortality and when only including propensity matched studies. CONCLUSIONS Perioperative red blood transfusion appears to be associated with a significant reduction in long-term survival for patients after cardiac surgery. Strategies such as preoperative optimisation, intraoperative blood conservation, judicious use of postoperative transfusions, and professional development into minimally invasive techniques should be utilised where appropriate to minimise the need for perioperative transfusions.
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Cho S, Park J, Lee M, Lee D, Choi H, Gim G, Kim L, Kang CY, Oh Y, Viveiros P, Vagia E, Oh MS, Cho GJ, Bharat A, Chae YK. Blood transfusions may adversely affect survival outcomes of patients with lung cancer: a systematic review and meta-analysis. Transl Lung Cancer Res 2021; 10:1700-1710. [PMID: 34012786 PMCID: PMC8107741 DOI: 10.21037/tlcr-20-933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Despite common use in clinical practice, the impact of blood transfusions on prognosis among patients with lung cancer remains unclear. The purpose of the current study is to perform an updated systematic review and meta-analysis to evaluate the influence of blood transfusions on survival outcomes of lung cancer patients. Methods We searched PubMed, Embase, Cochrane Library, and Ovid MEDLINE for publications illustrating the association between blood transfusions and prognosis among people with lung cancer from inception to November 2019. Overall survival (OS) and disease-free survival (DFS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using the random-effects model. Study heterogeneity was evaluated with the I2 test. Publication bias was explored via funnel plot and trim-and-fill analyses. Results We included 23 cohort studies with 12,175 patients (3,027 cases and 9,148 controls) for meta-analysis. Among these records, 22 studies investigated the effect of perioperative transfusions, while one examined that of transfusions during chemotherapy. Two studies suggested the possible dose-dependent effect in accordance with the number of transfused units. In pooled analyses, blood transfusions deleteriously influenced both OS (HR=1.35, 95% CI: 1.14–1.61, P<0.001, I2=0%) and DFS (HR=1.46, 95% CI: 1.15–1.86, P=0.001, I2=0%) of people with lung cancer. No evidence of significant publication bias was detected in funnel plot and trim-and-fill analyses (OS: HR=1.26, 95% CI: 1.07–1.49, P=0.006; DFS: HR=1.35, 95% CI: 1.08–1.69, P=0.008). Conclusions Blood transfusions were associated with decreased survival of patients with lung cancer.
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Affiliation(s)
- Sukjoo Cho
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jonghanne Park
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Misuk Lee
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dongyup Lee
- Department of Physical Medicine and Rehabilitation, Geisinger Health System, Danville, PA, USA
| | - Horyun Choi
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA
| | - Gahyun Gim
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Leeseul Kim
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cyra Y Kang
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Youjin Oh
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pedro Viveiros
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elena Vagia
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael S Oh
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ankit Bharat
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Young Kwang Chae
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
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Computer-assisted subtyping and prognosis for non-small cell lung cancer patients with unresectable tumor. Comput Med Imaging Graph 2018; 67:1-8. [DOI: 10.1016/j.compmedimag.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/10/2018] [Accepted: 04/02/2018] [Indexed: 11/21/2022]
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Li SL, Ye Y, Yuan XH. Association between Allogeneic or Autologous Blood Transfusion and Survival in Patients after Radical Prostatectomy: A Systematic Review and Meta-Analysis. PLoS One 2017; 12:e0171081. [PMID: 28135341 PMCID: PMC5279775 DOI: 10.1371/journal.pone.0171081] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/16/2017] [Indexed: 01/11/2023] Open
Abstract
Background A number of studies have investigated the effect of perioperative blood transfusion (PBT) for patients after radical prostatectomy (RP), with some reporting conflicting results. A systematic review of the literature and a meta-analysis were conducted to explore the association between PBT (autologous or allogeneic) and biochemical recurrence-free survival (BRFS), overall survival (OS) and cancer-specific survival (CSS) in patients undergoing RP. Methods The PubMed, Medline, Cochrane Library, and Embase databases were searched for published controlled clinical studies on perioperative allogeneic or autologous blood transfusion (BT) and patient survival after RP. STATA software version 12.0 was used for data analysis. We used hazard ratios (HRs) and 95% confidence intervals (CIs) to test the correlation between BT and patient survival after RP. Results Data from a total of 26,698 patients in ten published studies were included in the meta-analysis. The meta-analysis results showed that autologous BT was not associated with BRFS (HR: 1.06; 95% CI: 0.96–1.18; Z = 1.17; P = 0.24), OS (HR: 0.86; 95% CI: 0.71–1.04; Z = 1.58; P = 0.11), or CSS (HR: 0.98; 95% CI: 0.49–1.96; Z = 0.05; P = 0.96). Allogeneic BT exhibited a significant association with worse BRFS (HR: 1.09; 95% CI: 1.01–1.16; Z = 2.37; P = 0.02), OS (HR: 1.43; 95% CI: 1.24–1.64; Z = 4.95; P<0.01) and CSS (HR: 1.74; 95% CI: 1.18–2.56; Z = 2.81; P = 0.005). Conclusion Our data showed an association between allogeneic BT and reduced BRFS, OS and CSS in patients after RP. These findings indicate that perioperative blood conservation strategies are important for decreasing the allogeneic BT rate.
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Affiliation(s)
- Su-Liang Li
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
| | - Yun Ye
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
- * E-mail:
| | - Xiao-Hua Yuan
- Department of Blood Transfusion, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
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Kraus KA, Clifford CA, Davis GJ, Kiefer KM, Drobatz KJ. Outcome and Prognostic Indicators in Cats Undergoing Splenectomy for Splenic Mast Cell Tumors. J Am Anim Hosp Assoc 2015; 51:231-8. [PMID: 26083443 DOI: 10.5326/jaaha-ms-6280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This was a multi-institutional retrospective study evaluating the outcome and clinical parameters associated with the postoperative prognosis of 36 cats with splenic mast cell tumors treated with splenectomy. Clinical parameters reviewed included signalment, clinical history, results of staging tests, surgical variables, administration of blood products, presence of metastasis, postoperative complications, administration of chemotherapy postoperatively, chemotherapy protocol, and response to chemotherapy. Overall median survival time was 390 days (range, 2-1737 days). Administration of a blood product (P < .0001), metastasis to a regional lymph node (P = .022), and evidence of either concurrent or historical neoplasia (P = .037) were negatively associated with survival. Response to chemotherapy (P = .0008) was associated with an improved median survival time. Larger-scale prospective studies evaluating different chemotherapy protocols are required to elucidate the discrepancy between lack of survival benefit with administration of chemotherapy and improvement in survival time with positive response to chemotherapy.
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Affiliation(s)
- Kelly A Kraus
- From the Surgery Department, Red Bank Veterinary Hospital, Tinton Falls, NJ (K.A.K., G.D.); Hope Veterinary Specialists, Malvern, PA (C.C.); Department of Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN (K.M.K.); and the Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA (K.D.)
| | - Craig A Clifford
- From the Surgery Department, Red Bank Veterinary Hospital, Tinton Falls, NJ (K.A.K., G.D.); Hope Veterinary Specialists, Malvern, PA (C.C.); Department of Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN (K.M.K.); and the Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA (K.D.)
| | - Garrett J Davis
- From the Surgery Department, Red Bank Veterinary Hospital, Tinton Falls, NJ (K.A.K., G.D.); Hope Veterinary Specialists, Malvern, PA (C.C.); Department of Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN (K.M.K.); and the Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA (K.D.)
| | - Kristina M Kiefer
- From the Surgery Department, Red Bank Veterinary Hospital, Tinton Falls, NJ (K.A.K., G.D.); Hope Veterinary Specialists, Malvern, PA (C.C.); Department of Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN (K.M.K.); and the Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA (K.D.)
| | - Kenneth J Drobatz
- From the Surgery Department, Red Bank Veterinary Hospital, Tinton Falls, NJ (K.A.K., G.D.); Hope Veterinary Specialists, Malvern, PA (C.C.); Department of Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN (K.M.K.); and the Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA (K.D.)
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Luan H, Ye F, Wu L, Zhou Y, Jiang J. Perioperative blood transfusion adversely affects prognosis after resection of lung cancer: a systematic review and a meta-analysis. BMC Surg 2014; 14:34. [PMID: 24884867 PMCID: PMC4057617 DOI: 10.1186/1471-2482-14-34] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/19/2014] [Indexed: 01/02/2023] Open
Abstract
Background It is speculated that blood transfusion may induce adverse consequences after cancer surgery due to immunosuppression. This study was intended to assess the impact of perioperative blood transfusion on the prognosis of patients who underwent lung cancer resection. Methods Eligible studies were identified through a computerized literature search. The pooled relative risk ratio (RR) with 95% confidence interval (CI) was calculated using Review Manager 5.1 Software. Results Eighteen studies with a total of 5915 participants were included for this meta-analysis. Pooled analysis showed that perioperative blood transfusion was associated with worse overall survival (RR: 1.25, 95% CI: 1.13-1.38; P <0.001) and recurrence-free survival (RR: 1.42, 95% CI: 1.20-1.67; P <0.001) in patients with resected lung cancer. Conclusions Perioperative blood transfusion appears be associated with a worse prognosis in patients undergoing lung cancer resection. These data highlight the importance of minimizing blood transfusion during surgery.
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Affiliation(s)
| | | | | | - Yanming Zhou
- Department of Hepatobiliary & Pancreatovascular Surgery, Oncologic Center of Xiamen; First affiliated Hospital of Xiamen University, Xiamen 361003, China.
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Wang T, Luo L, Huang H, Yu J, Pan C, Cai X, Hu B, Yin X. Perioperative Blood Transfusion Is Associated With Worse Clinical Outcomes in Resected Lung Cancer. Ann Thorac Surg 2014; 97:1827-37. [DOI: 10.1016/j.athoracsur.2013.12.044] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/02/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
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The effect of intra- and postoperative allogenic blood transfusion on patients' survival undergoing radical cystectomy for urothelial carcinoma of the bladder. World J Urol 2014; 32:1447-53. [PMID: 24510120 DOI: 10.1007/s00345-014-1257-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 01/29/2014] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Radical cystectomy (RC) can be associated with significant blood loss. Allogenic blood transfusion (ABT) may alter disease outcome because of a theoretical immunomodulatory effect. We evaluated the effects of ABT on overall survival (OS) and progression-free survival (PFS) of patients undergoing RC for urothelial carcinoma of the bladder (UCB). MATERIALS AND METHODS This is a retrospective single-center study of 350 consecutive patients of a university health center with a median follow-up of 70.1 month. All patients underwent RC and pelvic lymph node dissection. The effect of ABT on OS and PFS was analyzed using univariable and multivariable Cox proportional hazards models. RESULTS The overall ABT rate was 63 % (n = 219), with intraoperative blood transfusion and postoperative blood transfusion being performed in 183 patients (52 %) and 99 patients (28 %), respectively. Preoperative anemia was detected in 156 patients (45 %) with median estimated blood loss of 800 ml (IQR: 500-1,200). ABT was associated with significant decrease of OS and PFS in multivariable analyses (p < 0.001), whereas patients' prognosis worsened the more packed red blood cells (PRBC) were transfused (p < 0.001). The study is limited in part due to its retrospective design. CONCLUSIONS We found that ABT and the number of PRBC transfused are associated with poor prognosis for UCB patients undergoing RC, whereas preoperative anemia had no influence on survival. This emphasizes the importance of surgeon's awareness for a strict indication for ABT. A prospective study will be necessary to evaluate the independent risks associated with ABT during surgical treatments.
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Churchhouse AMD, Mathews TJ, McBride OMB, Dunning J. Does blood transfusion increase the chance of recurrence in patients undergoing surgery for lung cancer? Interact Cardiovasc Thorac Surg 2011; 14:85-90. [PMID: 22108935 DOI: 10.1093/icvts/ivr025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether blood transfusion increases the chance of recurrence in patients undergoing surgery for lung cancer. Altogether 468 papers were found using the reported search, of which 21 represented the best evidence to answer the clinical question. The authors, journal date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. Nineteen cohort studies (two of which examined the same or similar data sets as two other studies already included), one comment article and one meta-analysis were identified. In total, the outcomes of 5378 patients undergoing surgical resection for lung cancer were analysed. The transfusion rate varied between 15 and 67%. The primary endpoints in all 21 papers were recurrence, survival or disease-free survival. We conclude that the research undertaken to examine the relationship between blood transfusion and lung cancer recurrence, survival and disease-free survival comes to no definite conclusion. Half of the papers relating to recurrence state that there is no significantly increased risk of recurrence with transfusion, whereas the other half state that there is. However, four of the five papers examining disease-free survival demonstrate a significant adverse relationship between this primary outcome and blood transfusion. With regard to survival, five of the papers reviewed showed no effect of blood transfusion, whereas five showed some form of adverse effect. Although there is no overwhelming agreement among the presented evidence, there is a slightly larger body of evidence supporting the theory that blood transfusions are associated with poorer outcomes in patients undergoing resection for lung cancer. However, whether this is a direct effect, or a surrogate marker for other factors such as anaemia, is unclear.
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Gallina A, Briganti A, Chun FKH, Walz J, Hutterer GC, Erbersdobler A, Eichelberg C, Schlomm T, Ahyai SA, Perrotte P, Saad F, Montorsi F, Huland H, Graefen M, Karakiewicz PI. Effect of autologous blood transfusion on the rate of biochemical recurrence after radical prostatectomy. BJU Int 2007; 100:1249-53. [PMID: 17850374 DOI: 10.1111/j.1464-410x.2007.07147.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To test the association between autologous blood transfusion (ABT) and biochemical recurrence (BCR) after radical prostatectomy (RP) in a large group of contemporary patients. PATIENTS AND METHODS We analysed 1291 patients treated with RP; Kaplan-Meier analysis was used to graphically explore the association between ABT and BCR. Cox regression models addressed the association between ABT and BCR in univariate and multivariate analyses, after adjusting for preoperative prostate specific antigen level, pathological Gleason sum, extracapsular extension, seminal vesicle invasion and lymph node invasion. RESULTS Of all patients, 205 (15.4%) received perioperative ABT. The mean (median, range) follow-up was 43.2 (40.9, 0.3-145) months. BCR was recorded in 347 (26.9%) patients and the time to BCR was 25.2 (20.5, 0.3-107) months. Neither in univariate (P = 0.053) nor in multivariate (P = 0.2) Cox regression analyses was ABT a statistically significant or independent predictor of BCR. CONCLUSION Perioperative ABT does not predispose to a higher rate of BCR in patients after RP.
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Affiliation(s)
- Andrea Gallina
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
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Paul R, Schmid R, Busch R, van Randenborgh H, Alschibaja M, Schöler S, Hartung R. Influence of blood transfusions during radical retropubic prostatectomy on disease outcome. Urology 2006; 67:137-41. [PMID: 16413349 DOI: 10.1016/j.urology.2005.07.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Revised: 06/16/2005] [Accepted: 07/12/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Blood transfusion in patients with malignant neoplasms may alter the disease outcome because of a theoretical immunomodulatory effect. This effect may reduce prostate-specific antigen (PSA)-free and disease-specific survival in patients with prostate cancer after radical prostatectomy. However, the results in published studies have been contradictory, and this effect has not yet been determined. METHODS We evaluated 1412 patients after radical prostatectomy from 1984 to 2003 in a retrospective analysis, with a special focus on the rate and type of blood transfusions, specifically heterologous versus autologous blood. Univariate analysis and Cox regression analysis were performed to evaluate the impact of blood transfusions on disease outcome. RESULTS The overall transfusion rate was 56.7%. The rate dropped from 88.9% in 1988 to 9.1% in 2002. PSA recurrence (greater than 0.5 ng/mL) was noted in 11.0% in patients without and in 26.0% with blood transfusions, which was not statistically significant on Kaplan-Meier analysis. Again, no difference was noted when patients were stratified according to the type (autologous versus heterologous) or the amount (2 U or less versus more than 2 U) of blood transfusion. Evaluating overall survival, again no differences were found. The established Cox regression model also proved that blood transfusions had no impact on disease outcome. CONCLUSIONS Our retrospective analysis did not detect any effect of blood transfusions in patients with prostate cancer after radical prostatectomy. If a negative adverse effect occurs, this effect must be minimal. However, the infectious risk and the costs of blood transfusions should be reason enough to reduce blood loss and the transfusion rate further in patients with prostate cancer.
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Affiliation(s)
- Roger Paul
- Department of Urology, Technischen Universität München, Klinikum rechts der Isar, Munich, Germany.
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Rolle A, Günzel R, Pachmann U, Willen B, Höffken K, Pachmann K. Increase in number of circulating disseminated epithelial cells after surgery for non-small cell lung cancer monitored by MAINTRAC(R) is a predictor for relapse: A preliminary report. World J Surg Oncol 2005; 3:18. [PMID: 15801980 PMCID: PMC1087511 DOI: 10.1186/1477-7819-3-18] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2004] [Accepted: 03/31/2005] [Indexed: 11/12/2022] Open
Abstract
Background Lung cancer still remains one of the most commonly occurring solid tumors and even in stage Ia, surgery fails in 30% of patients who develop distant metastases. It is hypothesized that these must have developed from occult circulating tumor cells present at the time of surgery, or before. The aim of the present study was to detect such cells in the peripheral blood and to monitor these cells following surgery. Methods 30 patients treated for lung cancer with surgery were monitored for circulating epithelial cells (CEC) by taking peripheral blood samples before, 2 weeks and 5 months after surgery and/or radiotherapy (RT) chemotherapy (CT) or combined RT/CT using magnetic bead enrichment and laser scanning cytometry (MAINTRAC®) for quantification of these cells. Results In 86% of the patients CEC were detected before surgery and in 100% at 2 weeks and 5 months after surgery. In the control group, which consisted of 100 normal donors without cancer, 97 % were negative for CEC. A significantly higher number of CEC was found preoperatively in patients with squamous cell carcinoma than in those with adenocarcinoma. In correlation to the extent of parenchymal manipulation 2 weeks after surgery, an increase in numbers of CEC was observed with limited resections (18/21) whereas pneumonectomy led to a decrease (5/8) of CEC, 2 weeks after surgery. The third analysis done 5 months after surgery identified 3 groups of patients. In the group of 5 patients who received neo- or adjuvant chemo/radiotherapy there was evidence that monitoring of CEC can evaluate the effects of therapy. Another group of 7 patients who underwent surgery only showed a decrease of CEC and no signs of relapse. A third group of 11 patients who had surgery only, showed an increase of CEC (4 with an initial decrease after surgery and 7 with continuous increase). In the group with a continuous increase during the following 24 months, 2 early relapses in patients with stage Ia adenocarcinoma were observed. The increase of CEC preceded clinical detection by six months. Conclusion We consider, therefore, that patients with adenocarcinoma and a continuous increase of CEC after complete resection for lung cancer are at an increased risk of early relapse.
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Affiliation(s)
- Axel Rolle
- Fachkrankenhaus Coswig/Dresden, der Friedrich-Schiller-Universität Jena, Germany
| | - Rainer Günzel
- Fachkrankenhaus Coswig/Dresden, der Friedrich-Schiller-Universität Jena, Germany
| | - Ulrich Pachmann
- TZB Transfusionsmedizinisches Zentrum Bayreuth, der Friedrich-Schiller-Universität Jena, Germany
| | - Babette Willen
- TZB Transfusionsmedizinisches Zentrum Bayreuth, der Friedrich-Schiller-Universität Jena, Germany
| | - Klaus Höffken
- Klinik für Innere Medizin II der Friedrich-Schiller-Universität Jena, Germany
| | - Katharina Pachmann
- TZB Transfusionsmedizinisches Zentrum Bayreuth, der Friedrich-Schiller-Universität Jena, Germany
- Klinik für Innere Medizin II der Friedrich-Schiller-Universität Jena, Germany
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