Blood transfusion during liver cancer surgery linked with higher risk of cancer recurrence and death

June 02, 2019

Receiving a blood transfusion during curative surgery for the most common type of liver cancer (hepatocellular carcinoma) is associated with a much higher risk of cancer recurrence and dying prematurely, according to new research being presented at this year's Euroanaesthesia congress (the annual meeting of the European Society of Anaesthesiology) in Vienna, Austria (1-3 June).

The risk was markedly increased even when only a small amount of blood was transfused, researchers say. Findings showed that transfusion of 1 to 4 units of blood increased the risk of cancer recurrence by 23% and death by 55% compared to matched controls.

"Our findings from a large cohort highlighted a significant association between red blood cell transfusions and the risk of cancer recurrence as well as a dose-response relationship between the amount of transfusions and death after curative surgery for liver cancer", says Dr Ying-Hsuan Tai from Taipei Medical University Shuang Ho Hospital in Taiwan who led the research.

"The reason why blood transfusions substantially worsen cancer prognosis remains unclear, but it is likely to be related to the suppressive effects on the immune system."

Hepatocellular carcinoma (HCC) is the fifth most common form of cancer worldwide and the third most common cause of cancer-related deaths. It occurs frequently in people with cirrhosis (scarring of the liver) due to previous damage from hepatitis B or C virus, or long-term alcohol abuse.

Surgery to remove the cancer and a margin of healthy tissue that surrounds it (resection) is a curative treatment for people with early-stage liver cancers who have normal liver function. Whilst advances in liver surgery have reduced operative blood loss considerably, liver resection still carries the risk of excessive blood loss and need for blood transfusion.

The extent to which blood transfusion worsens cancer outcomes after surgery is poorly understood. For several decades, research has reported conflicting findings, and has been unable to conclude whether blood transfusion itself is causing problems, or if other factors such as the underlying medical conditions that make surgery necessary might be to blame.

In this study, Tai and colleagues investigated the effect of perioperative blood transfusion on cancer prognosis following HCC resection in 1,469 patients without lymph node involvement or metastasis undergoing surgery at Taipei Veterans General Hospital, Taipei, Taiwan between 2005 and 2016. Researchers assessed postoperative disease-free survival and overall survival up to September 2018. Using statistical modelling (a technique called inverse probability of treatment weighting) they were able to match patients who had equivalent age and health conditions when comparing their outcomes.

Almost 1 in 3 patients (30%; 447 patients) received 1 to 4 units of allogeneic (from another individual) blood during or within 7 days of surgery, whilst more than 1 in 10 (12%; 179 patients) were given more than 4 units.

During a median 45 month follow-up, analyses showed that cancer was 23% more likely to recur in patients who received a transfusion (1-4 units) compared to those not given a transfusion, whilst those who received more than 4 units faced a 18% greater risk of recurrence compared with those who received none.*

Compared to those not given a transfusion, patients given 1-4 units of blood were 55% more likely to die from any cause, whilst those receiving 4 or more units had almost double the risk of death.

The authors conclude: "These data highlight the need for randomised trials to evaluate the influence of transfusion on cancer outcome and identify the level of anaemia that patients undergoing liver cancer surgery can withstand (or the minimum amount of blood they need to have transfused) with minimal adverse effects in order to guide practice. Until these trials have been completed, surgeons should use practices that reduce the risk of bleeding and the need for transfusion."
-end-


ESA (European Society of Anaesthesiology)

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.