BLOOD TRANSFUSION-MODULATED TUMOR RECURRENCE - FIRST RESULTS OF A RANDOMIZED STUDY OF AUTOLOGOUS VERSUS ALLOGENEIC BLOOD-TRANSFUSION IN COLORECTAL-CANCER SURGERY

Purpose: Allogeneic blood transfusions have reportedly associated with a poor prognosis in patients with curatively resected cancer. To cont rol for immunosuppression induced by a speculatively causal allogeneic blood transfusion, we designed a randomized study in which the contro l group received autologous blood transfusions not related to any cond ition of immunosuppression. Patients and Methods: One hundred twenty p atients with potentially curative resectable colorectal cancer and the capability to predeposit autologous blood were randomly selected to r eceive either standard allogeneic blood transfusion or predeposited au tologous blood. Results: In curatively resected cancer patients, the n umber who needed allogeneic blood transfusions was reduced from 60% in the allogeneic blood group to 33% in the autologous blood group (P =. 009). After a median follow-up duration of 22 months (range, 8 to 48) tumor recurrence was observed in 28.9% of the allogeneic blood group a nd 16.7% of the autologous blood group. Life-cable analysis establishe d a tendency toward a shorter tumor-free survival for the allogeneic b lood group (log-rank P =.11). The problem with this analysis was the s trong association of allogeneic blood transfusions with tumor recurren ce, which interfered in 33% of patients in the autologous blood group who required additional allogeneic blood transfusions. Multivariate an alysis of established risk factors for tumor recurrence and surgery-re lated variables reflecting potential immunosuppressive conditions show ed that only pT stage (relative risk, 6.61; 95% confidence interval [C I], 1.82 to 23.99; P =.004), pN stage (relative risk, 8.39; 95% CI, 3. 15 to 22.33; P <.001), and the need for allogeneic blood (relative ris k, 6.18; 95% CI, 2.20 to 17.37; P <.001) were independent predictors o f rumor recurrence. Subgroup analysis of patients who received a trans fusion of less than or equal to 2 U blood found a significantly higher risk of tumor recurrence in the allogeneic blood group (relative risk , 5.16; 95% CI, 1.13 to 23.62; P =.034), which was reduced to borderli ne significance (relative risk, 3.54; 95% CI, 0.76 to 16.51; P =.107) by adjustment for tumor (T) and node (N) stage. Conclusion: As indicat ed by these first results, the blood transfusion modality has a signif icant effect on tumor recurrence after surgical treatment of colorecta l cancer. A change in the practice of blood transfusion might thus pot entially surpass the impact of any recent adjuvant treatment strategie s. (C) 1994 by American Society of Clinical Oncology.