ASO Author Reflections: Association Between Perioperative Blood Transfusion, Infections, and Prognosis of Stage II/III G
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Association Between Perioperative Blood Transfusion, Infections, and Prognosis of Stage II/III Gastric Cancer Patients Hua Xiao, MD1,2
, and Jia Luo, MD1
1
Department of Hepatobiliary and Intestinal Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China; 2Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
PAST
PRESENT
Blood transfusion was required in approximately 20% of gastric cancer patients due to anemia when admitted or massive hemorrhage during radical gastrectomy with D2 lymphadenectomy.1 Transfusion-related immune modulation and systemic inflammation induced by transfusion not only leads to a higher incidence of postoperative infection but also poorer prognosis. Although both blood transfusion and postoperative infectious complications can cause a strong inflammatory response and results in a pro-tumor environment, whether a synergistic unfavorable effect could be observed for the survival of gastric cancer patients experiencing both transfusion and infections has never been investigated. On the other hand, postoperative complications have been identified to have an adverse impact on completion of complete multimodality therapy, and can lead to poorer prognosis.2 Considering that infection was a common and sometimes severe complication, whether it could adversely impact the completion of perioperative chemotherapy remains unclear. In addition, whether complete perioperative chemotherapy could mitigate the adverse influence of transfusion and infection on the prognosis of gastric cancer patients deserves further investigation.
In the present study including 2114 stage II/III gastric cancer patients receiving radical gastrectomy, infection was identified as the most common complication and blood transfusion was identified as an independent risk factor.3 Additionally, blood transfusion was associated with poorer prognosis, independent of infections, and receiving transfusion and developing infections had an additive effect that was associated with even worse cancer-specific survival. However, complete perioperative chemotherapy (six or more cycles) could significantly improve prognosis in these patients. Further analysis showed that neoadjuvant chemotherapy was a protective factor to complete perioperative chemotherapy, but not increase postoperative complications.
Ó Society of Surgical Oncology 2020 First Received: 26 August 2020 Accepted: 28 August 2020 J. Luo, MD e-mail: [email protected]
FUTURE Further studies should investigate whether strategies to reduce the requirement for transfusion, such as perioperative iron supplementation and restrictive transfusion practice (hemoglobin \ 70 or 75 g/L),4,5 could decrease the incidence of infection and improve survival. In addition, in order to complete perioperative chemotherapy and negate the
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