Anemia tolerance versus blood transfusion on long-term outcomes after colorectal cancer surgery: A retrospective propensity-score-matched analysis

Meilin Weng; Miaomiao Guo; Ting Li; Changming Zhou; Caihong Sun; Ying Yue; Qingwu Liao; Sanjun Cai; Xihua Lu; Di Zhou; Changhong Miao

doi:10.3389/fonc.2022.940428

Anemia tolerance versus blood transfusion on long-term outcomes after colorectal cancer surgery: A retrospective propensity-score-matched analysis

Front Oncol. 2022 Aug 15:12:940428. doi: 10.3389/fonc.2022.940428. eCollection 2022.

Authors

Meilin Weng^{1

2

3}, Miaomiao Guo^{1

2}, Ting Li^{1

2}, Changming Zhou⁴, Caihong Sun^{1

2}, Ying Yue^{1

2}, Qingwu Liao^{1

2}, Sanjun Cai⁵, Xihua Lu⁶, Di Zhou^{1

2}, Changhong Miao^{1

2}

Affiliations

¹ Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China.
² Shanghai Key Laboratory of Perioperative Stress and Protection, Zhongshan Hospital Fudan University, Shanghai, China.
³ Department of Anesthesiology, Shanghai Cancer Center, Fudan University, Shanghai, China.
⁴ Department of Cancer Prevention, Shanghai Cancer Center, Fudan University, Shanghai, China.
⁵ Department of Colorectal Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China.
⁶ Department of Anesthesiology, Affiliated Cancer Hospital of Zhengzhou University, Henan, China.

Abstract

Background: Perioperative anemia and transfusion are intertwined with each other, and both have adverse impacts on the survival of colorectal cancer (CRC) patients. But the treatment of anemia still relies on transfusion in several countries, which leads us to question the effects of anemia tolerance and transfusion on the long-term outcomes of CRC patients. We investigated the combined effect of preoperative anemia and postoperative anemia and of preoperative anemia and blood transfusion, which imposes a greater risk to survival, to compare the effects of anemia tolerance and transfusion on overall survival (OS) and disease-free survival (DFS) in patients undergoing CRC surgery.

Methods: A retrospective propensity-score-matched analysis included patients with CRC undergoing elective surgery between January 1, 2008, and December 31, 2014. After propensity-score matching, Kaplan-Meier survival analysis and univariable and multivariable Cox proportional hazards models were used to study the prognostic factors for survivals. In univariate and multivariate Cox regression analysis, two novel models were built.

Results: Of the 8,121 patients with CRC, 1,975 (24.3%) and 6,146 (75.7%) patients presented with and without preoperative anemia, respectively. After matching, 1,690 patients remained in each group. In the preoperative anemia and postoperative anemia model, preoperative anemia and postoperative anemia was independent risk factor for OS (HR, 1.202; 95% CI, 1.043-1.385; P=0.011) and DFS (HR, 1.210; 95% CI, 1.050-1.395; P=0.008). In the preoperative anemia and transfusion model, preoperative anemia and transfused was the most dangerous independent prognostic factor for OS (HR, 1.791; 95% CI, 1.339-2.397; P<0.001) and DFS (HR, 1.857; 95% CI, 1.389-2.483; P<0.001). In patients with preoperative anemia, the OS and DFS of patients with transfusion were worse than those of patients without transfusion (P=0.026 in OS; P=0.037 in DFS).

Conclusions: Preoperative anemia and blood transfusion imposed a greater risk to OS and DFS in patients undergoing CRC surgery, indicating that the harm associated with blood transfusion was greater than that associated with postoperative anemia. These findings should encourage clinicians to be vigilant for the timely prevention and treatment of anemia, by appropriately promoting toleration of anemia and restricting the use of blood transfusion in patients with CRC.

Keywords: anemia tolerance and blood transfusion; colorectal cancer; long-term outcomes; preoperative anemia and postoperative anemia; preoperative anemia and transfusion; propensity-score-matched analysis.