Multiple Transfusions Bad for Cancer Surgery

The need for multiple transfusions during surgery for kidney or prostate cancer signals compromised survival, report two new studies.

In a prostate cancer study, researchers from the Mayo Clinic (Rochester, MN, USA) analyzed records of 7,547 patients who underwent prostatectomy at the Mayo Clinic between 1990 and 1999. They found no difference in outcomes for patients who had no transfusions or received up to four units of blood. However, patients who received more than five units of blood had three times the chance of dying of a cancer-specific disease compared to patients who received fewer or no transfusions. This effect remained significant even after adjusting for Gleason score, preoperative prostate-specific antigen (PSA), seminal vesicle involvement, margin status, and adjuvant therapy. The patients were more likely to have biochemical progression of prostate cancer as well as systemic progression of the disease.

In a kidney study, the same researchers traced outcomes for 2,442 patients treated for renal cell carcinoma from 1970 to 2002. Of those patients, 1,504 died, including 814 who died from kidney cancer. About 36% of all patients had received transfusions. Patients transfused during surgery for kidney cancer had a more-than-three-times greater risk of dying from the cancer within seven years of the surgery compared with non-transfused patients. Even when all variables including preoperative anemia, tumor stage, tumor size, nuclear grade, and histologic tumor necrosis were included, the transfusion patients had a statistically significant 48% greater risk of dying. The disease-specific survival rates at five years following surgery were 83.1% for patients who were not transfused compared with 51.7% for patients who were transfused. The findings were reported at the annual meeting of the American Urological Association, held in May 2006 in Atlanta (GA, USA).

"We really don't understand if there is a cause-and-effect relationship or whether this is just a marker of the extent of illness, said lead author Jonathan Routh, M.D. "We have a number of ideas why transfusions are associated with excess deaths in these patients, but because these are retrospective studies, they have to be judged with caution.”


Related Links:
The Mayo Clinic