af84ce96009c40dde4d3d88112ca4d7d pmc_9818188.pdf 9400c8d31802f62f27bb686eb5304f3c913222e2 pmc_9818188.pdf 3c87f23c116dfeea68e25b5d15c544b6e20bc0e41abc7e802a9c3cd42c19e52b pmc_9818188.pdf Title: Effect of Perioperative Blood Transfusions and Infectious Complications on Inflammatory Activation and Long-Term Survival Following Gastric Cancer Resection Subject: Background: The aim of this study was to evaluate the impact of perioperative blood transfusion and infectious complications on postoperative changes of inflammatory markers, as well as on disease-free survival (DFS) in patients undergoing curative gastric cancer resection. Methods: Multicenter cohort study in all patients undergoing gastric cancer resection with curative intent. Patients were classified into four groups based on their perioperative course: one, no blood transfusion and no infectious complication; two, blood transfusion; three, infectious complication; four, both transfusion and infectious complication. Neutrophil-to-lymphocyte ratio (NLR) was determined at diagnosis, immediately before surgery, and 10 days after surgery. A multivariate Cox regression model was used to analyze the relationship of perioperative group and dynamic changes of NLR with disease-free survival. Results: 282 patients were included, 181 in group one, 23 in group two, 55 in group three, and 23 in group four. Postoperative NLR changes showed progressive increase in the four groups. Univariate analysis showed that NLR change > 2.6 had a significant association with DFS (HR 1.55; 95% CI 1.06–2.26; p = 0.025), which was maintained in multivariate analysis (HR 1.67; 95% CI 1.14–2.46; p = 0.009). Perioperative classification was an independent predictor of DFS, with a progressive difference from group one: group two, HR 0.80 (95% CI: 0.40–1.61; p = 0.540); group three, HR 1.42 (95% CI: 0.88–2.30; p = 0.148), group four, HR 2.85 (95% CI: 1.64–4.95; p = 0.046). Conclusions: Combination of perioperative blood transfusion and infectious complications following gastric cancer surgery was related to greater NLR increase and poorer DFS. These findings suggest that perioperative blood transfusion and infectious complications may have a synergic effect creating a pro-inflammatory activation that favors tumor recurrence. Keywords: perioperative transfusion; infectious complications; inflammatory markers; gastric cancer; gastrectomy; patient blood management Author: Noelia Puértolas, Javier Osorio, Carlos Jericó, Coro Miranda, Maite Santamaría, Eva Artigau, Gonzalo Galofré, Elisenda Garsot, Alexis Luna, Aurora Aldeano, Carles Olona, Joan Molinas, Laura Pulido, Marta Gimeno and Manuel Pera Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Wed Jan 4 10:24:41 2023 CET ModDate: Wed Jan 4 10:28:45 2023 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 4725241 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- OGZCWM+VnURWPalladioL Type 1 Custom yes yes no 10 0 AFEQHM+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 LMERUX+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 UGSTFA+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 XWOCXD+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 LCJEVJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 47 0 CNXSVA+CMSY10 Type 1 Builtin yes yes no 72 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes no 79 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-08-09 02:25:04 CEST RepresentationInformation: pmc_9818188.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-08-02 02:20:38 CEST Size: 4725241 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 309 FreeObjects: 9 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Children: Item: Title: Study Design and Participants Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Data Collection Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Outcomes and Definitions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Statistical Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Children: Item: Title: Baseline Variables Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Dynamic Changes of Inflammatory Markers Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Effect of Postoperative Infectious Complications and Blood Transfusion on DFS Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Effect of Inflammatory Changes on DFS Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Info: Title: Effect of Perioperative Blood Transfusions and Infectious Complications on Inflammatory Activation and Long-Term Survival Following Gastric Cancer Resection Author: Noelia Puértolas, Javier Osorio, Carlos Jericó, Coro Miranda, Maite Santamaría, Eva Artigau, Gonzalo Galofré, Elisenda Garsot, Alexis Luna, Aurora Aldeano, Carles Olona, Joan Molinas, Laura Pulido, Marta Gimeno and Manuel Pera Subject: Background: The aim of this study was to evaluate the impact of perioperative blood transfusion and infectious complications on postoperative changes of inflammatory markers, as well as on disease-free survival (DFS) in patients undergoing curative gastric cancer resection. Methods: Multicenter cohort study in all patients undergoing gastric cancer resection with curative intent. Patients were classified into four groups based on their perioperative course: one, no blood transfusion and no infectious complication; two, blood transfusion; three, infectious complication; four, both transfusion and infectious complication. Neutrophil-to-lymphocyte ratio (NLR) was determined at diagnosis, immediately before surgery, and 10 days after surgery. A multivariate Cox regression model was used to analyze the relationship of perioperative group and dynamic changes of NLR with disease-free survival. Results: 282 patients were included, 181 in group one, 23 in group two, 55 in group three, and 23 in group four. Postoperative NLR changes showed progressive increase in the four groups. Univariate analysis showed that NLR change > 2.6 had a significant association with DFS (HR 1.55; 95% CI 1.06 2.26; p = 0.025), which was maintained in multivariate analysis (HR 1.67; 95% CI 1.14 2.46; p = 0.009). Perioperative classification was an independent predictor of DFS, with a progressive difference from group one: group two, HR 0.80 (95% CI: 0.40 1.61; p = 0.540); group three, HR 1.42 (95% CI: 0.88 2.30; p = 0.148), group four, HR 2.85 (95% CI: 1.64 4.95; p = 0.046). Conclusions: Combination of perioperative blood transfusion and infectious complications following gastric cancer surgery was related to greater NLR increase and poorer DFS. These findings suggest that perioperative blood transfusion and infectious complications may have a synergic effect creating a pro-inflammatory activation that favors tumor recurrence. Keywords: perioperative transfusion; infectious complications; inflammatory markers; gastric cancer; gastrectomy; patient blood management Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Wed Jan 04 10:24:41 CET 2023 ModDate: Wed Jan 04 10:28:45 CET 2023 ID: 0x22e59c912ad986341fd5587271f92b7b, 0x22e59c912ad986341fd5587271f92b7b Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: LMERUX+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 243 FontDescriptor: FontName: LMERUX+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: UGSTFA+URWPalladioL-Ital FontSubset: true FirstChar: 2 LastChar: 121 FontDescriptor: FontName: UGSTFA+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: CNXSVA+CMSY10 FontSubset: true FirstChar: 0 LastChar: 21 FontDescriptor: FontName: CNXSVA+CMSY10 Flags: 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