BLOOD-TRANSFUSION AS A RISK FACTOR FOR DEATH IN STAGE-III AND STAGE-IV OPERATIVE LARYNGEAL-CANCER

Objective: To evaluate the role of a blood transfusion in a patient po pulation with head and neck cancer that was treated with combined ther apy (surgery and radiation) . Design: Retrospective, nonrandomized end point study. Univariate and multivariate analysis of 24 variables, in cluding transfusion status. Setting: The Veterans Affairs Cooperative Study (Cooperative Studies Program 268). Patients:Patients in the surg ical arm of the study (166 patients) underwent surgery and postoperati ve radiation therapy for advanced (stage III and IV) laryngeal cancer. Main Outcome Measures: Identification of variables related to patient time to death. Results: The univariate analysis identified age, clini cal N (lymph node) class, primary tumor site, number of pathologically positive lymph nodes, extracapsular spread, pretreatment screening he matocrit, hematocrit and albumin level at 1 month after treatment, int raoperative fluids and units of blood, and total units of blood as sig nificant (P<.05). The stepwise multivariate models identified independ ent significance in clinical and pathologic node status, hematocrits a t both screening and 1 month, extracapsular spread, albumin level at 1 month, age, and primary site. The position of each variable within th e individual regression models varied. Conclusions: Clinical N class o r pathologic node status occupied the first position of predictive sig nificance in all models. Blood transfusion status never retained indep endent significance in any multivariate assessment.