Yonsei Med J.  2008 Dec;49(6):993-1003. 10.3349/ymj.2008.49.6.993.

Allogeneic Blood Transfusion Given Before Radiotherapy Is Associated with the Poor Clinical Outcome in Patients with Cervical Cancer

• Lim MC
• Kim JY
• Kim TH
• Park S
• Kong SY
• Yoon JH
• Kang S
• Seo SS
• Park SY

• KMID: 1782949
• DOI: http://doi.org/10.3349/ymj.2008.49.6.993

Abstract

PURPOSE
To analyze the effect of allogeneic blood transfusion on clinical outcome in 119 patients with stage IIB cervical cancer who were treated with radiotherapy +/- chemotherapy. PATIENTS AND METHODS: Medical records were examined for hemoglobin levels before and during radiotherapy, history of allogeneic blood transfusions and the time point when transfusions were given. These factors were retrospectively analyzed along with other clinical risk factors for influences on the patients' clinical outcomes. RESULTS: Thirty-two patients (26.9%) received packed red blood cell transfusion (mean, 3.4 units; range, 1-12 units) before or during radiotherapy. Median follow-up period was 39.3 months (range, 7.6-58.4 months). Patients with history of transfusion showed poorer metastasis-free survival and a trend toward poorer overall survival than non-transfused patients. When patients who received transfusions were sub-divided by the time of transfusion, those who received transfusions before radiotherapy had significantly poorer clinical outcome than those who received transfusions during radiotherapy. In a multivariable analysis, patients with pretreatment transfusion showed a higher risk of distant metastasis (HR = 3.75, 95% CI: 1.28-12.15, p = 0.017) and decreased overall survival rates (HR = 4.62, 95% CI: 1.15-18.54, p = 0.031) compared with those of other patients. CONCLUSION: Our results suggest that allogeneic blood transfusions given before radiotherapy may be associated with higher incidence of distant metastases and decreased survival in patients with stage IIB cervical cancer.

Keyword

Anemia; blood transfusion; cervical cancer; metastasis; radiotherapy

MeSH Terms

Adult
Aged
Aged, 80 and over
Anemia/etiology/therapy
Blood Transfusion/*adverse effects
Carcinoma, Squamous Cell/complications/radiotherapy/secondary/therapy
Female
Humans
Middle Aged
Prognosis
Treatment Outcome
Uterine Cervical Neoplasms/complications/*radiotherapy/*therapy
Young Adult

Figure

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  Fig. 1 Average weekly nadir hemoglobin values in patients who received blood transfusions before the initiation of radiotherapy (open circles) and in patients who did not receive transfusions (closed circles). Transfusion frequency in patients with (white column) and without (black column) pretreatment transfusions.

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  Fig. 2 Effect of laparoscopic lymph node dissection on anemia and transfusion. Closed circle and shaded column represent patients with laparoscopic surgery (n = 42). Open circle and white column represent patients without laparoscopic surgery (n = 77). PreOp, Hemoglobin at initial presentation; PreRT, Nadir hemoglobin at the time of initiation of radiotherapy.

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  Fig. 3 Effect of chemotherapy on hemoglobin and transfusion. Open circle and white column represent patients undergoing chemotherapy (n = 107), whereas, closed circle and black column for patients without chemotherapy (n = 12).

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  Fig. 4 Overall survival rate according to the age group, stratified by Baseline Hb 10g/dL. (A) Patients < 50 yrs, p = 0.36, (B) Patients ≥ 50 yrs, p = 0.028, p value calculated by log rank test. Solid line BHb ≥ 10 g/dL, Broken line BHb < 10 g/dL

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  Fig. 5 (A) Metastasis-free survival in patients with transfusion vs. non-transfusion (4-year MFS rates 72% vs. 87%, p = 0.007, p value calculated by log rank test). (B) Metastasis-free survival in patients with no transfusion, with transfusion only during treatment, or with transfusion before treatment (4-year MFS rates 87%, 78%, and 66%, respectively). (C) Overall survival in patients with no transfusion, with transfusion only during treatment, or with transfusion before treatment (4-year OS rates 88%, 92%, and 72%).

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