Perioperative blood transfusion has a dose-dependent relationship with disease recurrence and survival in patients with non–small cell lung cancer
Perioperative blood transfusions have been implicated in decreased overall survival (OS) and disease-free survival (DFS) after resection for non–small cell lung cancer (NSCLC). We investigated the effects of single- and multiple-unit blood transfusions on OS, DFS, and recurrence after anatomic pulmo...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2019-06, Vol.157 (6), p.2469-2477.e10 |
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| creator | Latif, M. Jawad Tan, Kay See Molena, Daniela Huang, James Bott, Matthew J. Park, Bernard J. Adusumilli, Prasad S. Rusch, Valerie W. Bains, Manjit S. Downey, Robert J. Jones, David R. Isbell, James M. |
| description | Perioperative blood transfusions have been implicated in decreased overall survival (OS) and disease-free survival (DFS) after resection for non–small cell lung cancer (NSCLC). We investigated the effects of single- and multiple-unit blood transfusions on OS, DFS, and recurrence after anatomic pulmonary resection.
From January 1, 2000, to June 30, 2016, 5709 consecutive patients underwent pulmonary resection for NSCLC at our institution. Exclusion criteria were stage IIIB-IV disease, incomplete resections, ill-defined histologic subtypes, and nonanatomic wedge resections. For the 0 versus single-unit analysis, propensity scores were calculated from a logistic regression model that predicted the probability of patients receiving a single-unit transfusion. The resulting matching weights were incorporated into Cox models for OS, DFS, and cumulative incidence of recurrence, to compare no versus single-unit blood transfusion. We determined whether increasing numbers of blood transfusions influenced survival or recurrence using multivariable Cox models.
Approximately 10% of patients received perioperative blood transfusion (median follow-up, 7.46 years [25th-75th percentile, 3.98-11.8]). There was no difference in OS, DFS, or cumulative incidence of recurrence between patients receiving no transfusion and those receiving single-unit transfusion (P > .05). However, a dose–response relationship was observed, demonstrating worse OS (overall P |
| doi_str_mv | 10.1016/j.jtcvs.2018.12.109 |
| format | Article |
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From January 1, 2000, to June 30, 2016, 5709 consecutive patients underwent pulmonary resection for NSCLC at our institution. Exclusion criteria were stage IIIB-IV disease, incomplete resections, ill-defined histologic subtypes, and nonanatomic wedge resections. For the 0 versus single-unit analysis, propensity scores were calculated from a logistic regression model that predicted the probability of patients receiving a single-unit transfusion. The resulting matching weights were incorporated into Cox models for OS, DFS, and cumulative incidence of recurrence, to compare no versus single-unit blood transfusion. We determined whether increasing numbers of blood transfusions influenced survival or recurrence using multivariable Cox models.
Approximately 10% of patients received perioperative blood transfusion (median follow-up, 7.46 years [25th-75th percentile, 3.98-11.8]). There was no difference in OS, DFS, or cumulative incidence of recurrence between patients receiving no transfusion and those receiving single-unit transfusion (P > .05). However, a dose–response relationship was observed, demonstrating worse OS (overall P < .001), DFS (overall P < .001), and recurrence (overall P = .010) with increasing units of blood transfused.
Although a single-unit blood transfusion did not affect survival in patients undergoing resection for NSCLC, greater unit perioperative blood transfusions were associated with significantly decreased long-term outcomes in a dose-dependent manner, suggesting avoidance or minimization of transfusions could improve long-term survival after lung resection.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2018.12.109</identifier><identifier>PMID: 30902468</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Blood Transfusion - statistics & numerical data ; Carcinoma, Non-Small-Cell Lung - mortality ; Carcinoma, Non-Small-Cell Lung - surgery ; Disease-Free Survival ; Female ; Humans ; lobectomy ; Logistic Models ; lung cancer ; Lung Neoplasms - mortality ; Lung Neoplasms - surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local - epidemiology ; Perioperative Period - statistics & numerical data ; Propensity Score ; propensity-score matching ; recurrence ; Retrospective Studies ; segmentectomy ; survival ; transfusion</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2019-06, Vol.157 (6), p.2469-2477.e10</ispartof><rights>2019 The American Association for Thoracic Surgery</rights><rights>Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-4b59bbb4dde5287df593ebacdfe3922633c0c527230b83e69609ad5cdd18fad33</citedby><cites>FETCH-LOGICAL-c459t-4b59bbb4dde5287df593ebacdfe3922633c0c527230b83e69609ad5cdd18fad33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2018.12.109$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,777,781,882,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30902468$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Latif, M. Jawad</creatorcontrib><creatorcontrib>Tan, Kay See</creatorcontrib><creatorcontrib>Molena, Daniela</creatorcontrib><creatorcontrib>Huang, James</creatorcontrib><creatorcontrib>Bott, Matthew J.</creatorcontrib><creatorcontrib>Park, Bernard J.</creatorcontrib><creatorcontrib>Adusumilli, Prasad S.</creatorcontrib><creatorcontrib>Rusch, Valerie W.</creatorcontrib><creatorcontrib>Bains, Manjit S.</creatorcontrib><creatorcontrib>Downey, Robert J.</creatorcontrib><creatorcontrib>Jones, David R.</creatorcontrib><creatorcontrib>Isbell, James M.</creatorcontrib><title>Perioperative blood transfusion has a dose-dependent relationship with disease recurrence and survival in patients with non–small cell lung cancer</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Perioperative blood transfusions have been implicated in decreased overall survival (OS) and disease-free survival (DFS) after resection for non–small cell lung cancer (NSCLC). We investigated the effects of single- and multiple-unit blood transfusions on OS, DFS, and recurrence after anatomic pulmonary resection.
From January 1, 2000, to June 30, 2016, 5709 consecutive patients underwent pulmonary resection for NSCLC at our institution. Exclusion criteria were stage IIIB-IV disease, incomplete resections, ill-defined histologic subtypes, and nonanatomic wedge resections. For the 0 versus single-unit analysis, propensity scores were calculated from a logistic regression model that predicted the probability of patients receiving a single-unit transfusion. The resulting matching weights were incorporated into Cox models for OS, DFS, and cumulative incidence of recurrence, to compare no versus single-unit blood transfusion. We determined whether increasing numbers of blood transfusions influenced survival or recurrence using multivariable Cox models.
Approximately 10% of patients received perioperative blood transfusion (median follow-up, 7.46 years [25th-75th percentile, 3.98-11.8]). There was no difference in OS, DFS, or cumulative incidence of recurrence between patients receiving no transfusion and those receiving single-unit transfusion (P > .05). However, a dose–response relationship was observed, demonstrating worse OS (overall P < .001), DFS (overall P < .001), and recurrence (overall P = .010) with increasing units of blood transfused.
Although a single-unit blood transfusion did not affect survival in patients undergoing resection for NSCLC, greater unit perioperative blood transfusions were associated with significantly decreased long-term outcomes in a dose-dependent manner, suggesting avoidance or minimization of transfusions could improve long-term survival after lung resection.</description><subject>Aged</subject><subject>Blood Transfusion - statistics & numerical data</subject><subject>Carcinoma, Non-Small-Cell Lung - mortality</subject><subject>Carcinoma, Non-Small-Cell Lung - surgery</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Humans</subject><subject>lobectomy</subject><subject>Logistic Models</subject><subject>lung cancer</subject><subject>Lung Neoplasms - mortality</subject><subject>Lung Neoplasms - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - epidemiology</subject><subject>Perioperative Period - statistics & numerical data</subject><subject>Propensity Score</subject><subject>propensity-score matching</subject><subject>recurrence</subject><subject>Retrospective Studies</subject><subject>segmentectomy</subject><subject>survival</subject><subject>transfusion</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc2KFDEQx4Mo7rj6BILk6KXHfEwynYOCLH7Bgh4UvIV0Ur2ToSdpU929ePMd9Al9EjPOuujFSwWq_r-qSv0JeczZmjOun-3X-8kvuBaMt2suatLcIasat41u1ee7ZMWYEI0SQp6RB4h7xtiWcXOfnElmmNjodkV-fIAS8wjFTXEB2g05BzoVl7CfMeZEdw6poyEjNAFGSAHSRAsMVZ8T7uJIr-O0oyEiOIRa8XMpkDxQlwLFuSxxcQONiY4VqTCegJTTz2_f8eCGgXqoYZjTFfWukuUhude7AeHRzXtOPr1-9fHibXP5_s27i5eXjd8oMzWbTpmu6zYhgBLtNvTKSOicDz1II4SW0jOvxFZI1rUStNHMuKB8CLztXZDynLw49R3n7gDB1-2KG-xY4sGVrza7aP-tpLizV3mxWgutNK8Nnt40KPnLDDjZQ8Tjb1yCPKMV3GglTLsRVSpPUl8yYoH-dgxn9uin3dvfftqjn5aLmjSVevL3hrfMHwOr4PlJAPVOS4Ri0cfj-UOsVkw25PjfAb8A9a659A</recordid><startdate>20190601</startdate><enddate>20190601</enddate><creator>Latif, M. 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Jawad ; Tan, Kay See ; Molena, Daniela ; Huang, James ; Bott, Matthew J. ; Park, Bernard J. ; Adusumilli, Prasad S. ; Rusch, Valerie W. ; Bains, Manjit S. ; Downey, Robert J. ; Jones, David R. ; Isbell, James M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-4b59bbb4dde5287df593ebacdfe3922633c0c527230b83e69609ad5cdd18fad33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Blood Transfusion - statistics & numerical data</topic><topic>Carcinoma, Non-Small-Cell Lung - mortality</topic><topic>Carcinoma, Non-Small-Cell Lung - surgery</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Humans</topic><topic>lobectomy</topic><topic>Logistic Models</topic><topic>lung cancer</topic><topic>Lung Neoplasms - mortality</topic><topic>Lung Neoplasms - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - epidemiology</topic><topic>Perioperative Period - statistics & numerical data</topic><topic>Propensity Score</topic><topic>propensity-score matching</topic><topic>recurrence</topic><topic>Retrospective Studies</topic><topic>segmentectomy</topic><topic>survival</topic><topic>transfusion</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Latif, M. Jawad</creatorcontrib><creatorcontrib>Tan, Kay See</creatorcontrib><creatorcontrib>Molena, Daniela</creatorcontrib><creatorcontrib>Huang, James</creatorcontrib><creatorcontrib>Bott, Matthew J.</creatorcontrib><creatorcontrib>Park, Bernard J.</creatorcontrib><creatorcontrib>Adusumilli, Prasad S.</creatorcontrib><creatorcontrib>Rusch, Valerie W.</creatorcontrib><creatorcontrib>Bains, Manjit S.</creatorcontrib><creatorcontrib>Downey, Robert J.</creatorcontrib><creatorcontrib>Jones, David R.</creatorcontrib><creatorcontrib>Isbell, James M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Latif, M. Jawad</au><au>Tan, Kay See</au><au>Molena, Daniela</au><au>Huang, James</au><au>Bott, Matthew J.</au><au>Park, Bernard J.</au><au>Adusumilli, Prasad S.</au><au>Rusch, Valerie W.</au><au>Bains, Manjit S.</au><au>Downey, Robert J.</au><au>Jones, David R.</au><au>Isbell, James M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Perioperative blood transfusion has a dose-dependent relationship with disease recurrence and survival in patients with non–small cell lung cancer</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2019-06-01</date><risdate>2019</risdate><volume>157</volume><issue>6</issue><spage>2469</spage><epage>2477.e10</epage><pages>2469-2477.e10</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Perioperative blood transfusions have been implicated in decreased overall survival (OS) and disease-free survival (DFS) after resection for non–small cell lung cancer (NSCLC). We investigated the effects of single- and multiple-unit blood transfusions on OS, DFS, and recurrence after anatomic pulmonary resection.
From January 1, 2000, to June 30, 2016, 5709 consecutive patients underwent pulmonary resection for NSCLC at our institution. Exclusion criteria were stage IIIB-IV disease, incomplete resections, ill-defined histologic subtypes, and nonanatomic wedge resections. For the 0 versus single-unit analysis, propensity scores were calculated from a logistic regression model that predicted the probability of patients receiving a single-unit transfusion. The resulting matching weights were incorporated into Cox models for OS, DFS, and cumulative incidence of recurrence, to compare no versus single-unit blood transfusion. We determined whether increasing numbers of blood transfusions influenced survival or recurrence using multivariable Cox models.
Approximately 10% of patients received perioperative blood transfusion (median follow-up, 7.46 years [25th-75th percentile, 3.98-11.8]). There was no difference in OS, DFS, or cumulative incidence of recurrence between patients receiving no transfusion and those receiving single-unit transfusion (P > .05). However, a dose–response relationship was observed, demonstrating worse OS (overall P < .001), DFS (overall P < .001), and recurrence (overall P = .010) with increasing units of blood transfused.
Although a single-unit blood transfusion did not affect survival in patients undergoing resection for NSCLC, greater unit perioperative blood transfusions were associated with significantly decreased long-term outcomes in a dose-dependent manner, suggesting avoidance or minimization of transfusions could improve long-term survival after lung resection.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30902468</pmid><doi>10.1016/j.jtcvs.2018.12.109</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Blood Transfusion - statistics & numerical data Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - surgery Disease-Free Survival Female Humans lobectomy Logistic Models lung cancer Lung Neoplasms - mortality Lung Neoplasms - surgery Male Middle Aged Neoplasm Recurrence, Local - epidemiology Perioperative Period - statistics & numerical data Propensity Score propensity-score matching recurrence Retrospective Studies segmentectomy survival transfusion |
| title | Perioperative blood transfusion has a dose-dependent relationship with disease recurrence and survival in patients with non–small cell lung cancer |
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