Journal of Clinical Oncology, Vol 3, 698-709, Copyright © 1985 by American Society of Clinical Oncology
Perioperative blood transfusions are associated with increased rates of recurrence and decreased survival in patients with high-grade soft- tissue sarcomas of the extremities
SA Rosenberg, CA Seipp, DE White and R Wesley
One hundred fifty-six patients with high-grade soft-tissue sarcomas of the
extremities treated on prospective randomized trials were analyzed to
determine the impact of perioperative blood transfusions on tumor
recurrence and patient survival. A significant increase in the incidence of
tumor recurrence and decrease in survival were associated with the receipt
of blood transfusions at the time of definitive surgical therapy of the
sarcoma. Actuarial 5-year continuous disease- free survival was 70% in
patients who had not been transfused compared to 48% in patients who
received one or more transfusions (P = .007). Overall 5-year survival was
also substantially decreased in patients receiving transfusions (85%
compared to 63%; P = .0035). A direct relationship existed between the
number of transfusions administered and the decrease in disease-free and
overall survival; the larger the number of transfusions the worse the
prognosis (P less than .0001 and P = .0001, respectively). A large number
of other prognostic factors were included in the analysis including the
age, sex, race of the patient, histology of the primary lesion, anatomic
site of the primary lesion, final surgical margins, size of the tumor, type
of surgery required, the use of chemotherapy, actual time in the operating
room under anesthesia, the exact anesthetic agent used, and the individual
surgeon who performed the operation. Accounting for all of these factors a
strong association continued to exist between the receipt of blood
transfusion and poor patient prognosis. We have previously shown that
adjuvant chemotherapy is of benefit to patients with high-grade extremity
sarcomas, and 132 (84.6%) of 156 patients in this series received
chemotherapy. In patients receiving chemotherapy, blood transfusions were
associated with increased recurrence (P less than .0001) and decreased
survival (P = .0001). The only other significant independent prognostic
variable in these patients was the size of the primary tumor. An analysis
of all patients, stratified for tumor size, revealed an impact of
transfusions on increasing recurrence (P = .007) and decreasing survival (P
= .016). An analysis of the subpopulation of patients with large tumors
(greater than 150 mL) gave the same results (P = .03 and .015,
respectively). It thus appears that the receipt of blood transfusions is
associated with increased tumor recurrence and decreased survival in
patients with high-grade soft-tissue sarcomas of the extremities.(ABSTRACT
TRUNCATED AT 400 WORDS)
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