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Do Packed Red Blood Cell Transfusions Really Worsen Oncologic Outcomes in Colon Cancer?
*Ramzi Amri, *Anne Dinaux, *Hiroko Kunitake, Liliana Bordeianou, David Berger
Harvard Medical School/Massachusetts General Hospital, Boston, MA

Objective: Several reports aggregating results from small retrospective studies have argued that perioperative packed red blood cell (PRBC) transfusions may increase the risk of developing metastatic recurrence. This abstract tests this assumption in a large cohort spanning a decade of surgically treated colon cancer patients.
Design: Retrospective review of prospectively maintained data repository.
Setting: Tertiary care center.
Patients: All patients undergoing primary resection of colon cancer in the 2004-2014 interval (n=1479).
Main outcome measures: Survival and disease-free survival, also adjusted in multivariable Cox regression standardized for follow-up, ASA score, age, sex, baseline staging, and tumor grade.
Results: Out 1479 patients, 304 (20.6%) received a PRBC transfusion during their index admission. During follow-up (median 43 vs. 28 months; P<0.001), mortality rates were unsurprisingly significantly higher in patients who received PRBC’s (51.6% vs. 30.4%;P<0.001). However, no appreciable differences in rates of long-term recurrence were identified. If anything, point estimates in multivariable Cox regression trend very slightly towards lower recurrence rates in patients with PRBC transfusions.

	PRBC transfusion	No PRBC transfusion	P	Hazard ratio* (95% CI)	P
Overall metastasis	28.3%	27.0%	0.65	0.97 (0.75-1.24)	0.80
Baseline metastasis	19.7%	16.0%	0.12	N/A	N/A
Metastatic recurrence	8.6%	11.0%	0.22	0.98 (0.62-1.54)	0.91
Excluding baseline mets	10.7%	13.1%	0.31
Death	51.6%	30.4%	<0.001	1.60 (1.30-2.00)	<0.001
* Time-standardized Cox regression adjusted for baseline staging (T-stage, N-stage, tumor grade, baseline metastasis), ASA score, age, sex, where applicable

Conclusions: Mortality rates were significantly higher in patients with PRBC transfusions, a finding which is backed by a large body of evidence that associates PRBC transfusion with comorbidity and serious illness, rather that it being specific to a unique disease. However, contrary to earlier evidence, findings in our cohort do not support a hypothesis that perioperative PRBC transfusions have a detrimental effect on recurrence rates of surgically treated colon cancer patients. Further research should explore the reasons behind the discrepancy.

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