Perioperative blood transfusion has distinct postsurgical oncologic impact on patients with different stage of hepatocellular carcinoma

• Published in: BMC cancer Vol. 20; no. 1; p. 487
• Main Authors: Chen, Gui-Xing, Qi, Chao-Ying, Hu, Wen-Jie, Wang, Xiao-Hui, Hua, Yun-Peng, Kuang, Ming, Peng, Bao-Gang, Li, Shao-Qiang
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.05.2020; BioMed Central; BMC
• Subjects: Adult; Aged; Bias; Blood clots; Blood Loss, Surgical - prevention & control; Blood platelets; Blood transfusion; Blood Transfusion - statistics & numerical data; Blood transfusions; Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Comparative analysis; Disease-Free Survival; Female; Follow-Up Studies; Hemoglobin; Hepatectomy; Hepatectomy - adverse effects; Hepatocellular carcinoma; Humans; Kaplan-Meier Estimate; Liver; Liver cancer; Liver diseases; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Lymphocytes; Male; Middle Aged; Mortality; Neoplasm Recurrence, Local; Neoplasm Staging; Neutrophils; Outcomes; Patients; Perioperative Care - adverse effects; Perioperative Care - statistics & numerical data; Propensity Score; Prospective Studies; Regression analysis; Retrospective Studies; Survival; Tumors; Veins & arteries; Hepatocellular carcinoma; Blood transfusion; Outcomes; Hepatectomy
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-020-06980-5

The influence of perioperative blood transfusion (PBT) on postsurgical survival of patients with different stage of hepatocellular carcinoma (HCC) is not well clarified. This study aimed to evaluate the impact of PBT on survival outcomes of different stage of HCC patients. Consecutive patients who underwent liver resection for HCC between January 2009 and November 2015 were identified from an HCC prospective database in authors' center. The survival outcomes were compared between patients receiving PBT and those without PBT before and after propensity score matching (PSM) in different stage subsets. Cox regression analysis was performed to verify the impact of PBT on outcomes of HCC. Among 1255 patients included, 804 (64.1%) were Barcelona Clinic Liver Cancer (BCLC) stage 0-A, and 347 (27.6%) received PBT. Before PSM, patients with PBT had worse disease free survival (DFS) and overall survival (OS) compared with those without PBT in both BCLC 0-A subset and BCLC B-C subset (all P < 0.05). After PSM, 288 pairs of patients (with and without PBT) were created. In the subset of BCLC 0-A, the median DFS of patients with PBT was shorter than those without PBT (12.0 months vs. 36.0 months, P = 0.001) Similar result was observed for OS (36.0 months vs. 96.0 months, P = 0.001). In the subset of BCLC B-C, both DFS and OS were comparable between patients with PBT and those without PBT. Cox regression analysis showed that PBT involved an increasing risk of DFS (HR = 1.607; P < 0.001) and OS (HR = 1.756; P < 0.001) for this subset. However, PBT had no impact on DFS (P = 0.126) or OS (P = 0.139) for those with stage B-C HCC. PBT negatively influenced oncologic outcomes of patient with BCLC stage 0-A HCC, but not those with stage B-C after curative resection.