(Chest. 2003;124:102-107.)
© 2003 American College of Chest Physicians
Correlation Between Perioperative Blood Transfusion and Prognosis of Patients Subjected to Surgery for Stage I Lung Cancer
Mario Nosotti, MD; Paolo Rebulla, MD; Donatella Riccardi, MD; Alessandro Baisi, MD; Nadia Bellaviti, MD; Lorenzo Rosso, MD and Luigi Santambrogio, MD
* From the Thoracic Surgery Unit (Drs. Nosotti, Baisi, Bellaviti, Rosso, and Santambrogio), Centro Trasfusionale e di Immunologia dei Trapianti (Drs. Rebulla and Riccardi), I.R.C.C.S. Ospedale Maggiore Policlinico, Milan, Italy.
Correspondence to: Mario Nosotti, MD, Thoracic Surgery Unit, Ospedale Maggiore Policlinico, I.R.C.C.S. Via F. Sforza, 35, 20122 Milan, Italy; e-mail:
marionosotti@libero.it
Background: It has been reported, but not proven, that perioperative blood transfusions have a detrimental effect on the survival of patients undergoing surgery for lung cancer.
Study design and methods: A prospective study was carried out on the patients undergoing lobectomy for stage I lung cancer at our department from 1995 to 2000. The criteria for exclusion included previous cases of malignancy, autoimmune diseases, and any other relevant comorbidity.
Results: Two hundred eighty-one patients were observed, 24.6% of whom received transfusions. The only significant difference between the transfused and nontransfused patients was their preoperative hemoglobin (Hb) concentration (12.5 ± 1.20 g/dL vs 13.3 ± 1.22 g/dL, p < 0.001). The disease-free interval of the transfused patients was significantly lower than that of the nontransfused patients (53% vs 78% at 73 months, p < 0.005), as was also the case for actuarial survival (52% vs 71% at 73 months, p < 0.02). Blood transfusion was significantly predictive of tumor relapse according to the Cox model adjusted for the T state, preoperative Hb concentration, sex, age, histologic type, and grading (hazard ratio, 2.3; p = 0.017).
Conclusions: Our data show that perioperative blood transfusion is significantly correlated to worse prognosis in patients undergoing surgery for stage I lung cancer.
Key Words: blood transfusion • lung neoplasms • recurrence
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