THE ASSOCIATION BETWEEN PERIOPERATIVE BLOOD-TRANSFUSION AND SURVIVAL OF PATIENTS WITH COLORECTAL-CANCER

Background. The authors undertook this study to test the hypothesis th at perioperative blood transfusion has an adverse effect on survival o f patients with colorectal cancer. Methods. A retrospective analysis w as performed on 725 patients who underwent curative resection for Duke s Stage B and C colorectal cancers in our institution between 1981-198 5 and who were followed for 5-11 years. Results. Rectal cancers occurr ed more frequently in the transfused than in the nontransfused patient s (64% versus 47%; P = 0.0001). In the patients with colon cancer, no significant effect of transfusion on recurrence-free survival was seen (P = 0.8, log-rank; P = 0.49, Cox regression analysis). The cumulativ e 5-year survival rate was 77% (95% confidence interval, 69-85%) for t he nontransfused and 78% (72-83%) for the transfused patients. In pati ents with rectal cancer, the 5-year survival rate was 79% (67-87%) for the nontransfused and 67% (59-71%) for the transfused patients. A sig nificant association was noted in patients with Stage B cancer (P = 0. 002, log-rank; P = 0.02, Cox regression analysis), but not in those wi th Stage C cancer (P = 0.05, log-rank; P = 0.15, Cox regression analys is). In patients with Stage B rectal cancer, more frequent abdominoper ineal resections (APR) were performed among the transfused patients (6 5% versus 32%; P = 0.0001). This subgroup was further stratified by op erative procedure and reanalyzed using the same Cox regression model. Transfusion had no effect on survival of patients treated by APR (P = 0.31) or of those having a sphincter-saving procedure (P = 0.53). Conc lusion. The seemingly adverse effect of perioperative blood transfusio n on the survival of patients with colorectal cancer may be explained by other covariates.