Effect of Perioperative Blood Transfusions and Infectious Complications on Inflammatory Activation and Long-Term Survival Following Gastric Cancer Resection
Puértolas, Noelia (Hospital Universitari de Bellvitge)
Osorio, Javier (Hospital Universitari de Bellvitge)
Jericó, Carlos (Hospital de Sant Joan Despí Moisès Broggi)
Miranda, Coro (Hospital Universitario de Navarra)
Santamaría, Maite (Hospital Arnau de Vilanova (Lleida, Catalunya))
Artigau, Eva (Hospital Universitari de Girona Doctor Josep Trueta)
Galofré, Gonzalo (Hospital de Sant Joan Despí Moisès Broggi)
Garsot, Elisenda (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Luna, Alexis (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Aldeano, Aurora (Hospital General de Granollers)
Olona, Carles (Hospital Universitari de Tarragona)
Molinas, Joan (Hospital Universitari de Vic)
Pulido, Laura (Hospital de Mataró. Consorci Sanitari del Maresme)
Gimeno, Marta (Hospital del Mar (Barcelona, Catalunya))
Pera Román, Manuel (Hospital del Mar (Barcelona, Catalunya))
Universitat Autònoma de Barcelona

Fecha:	2022
Resumen:	Both postoperative complications and perioperative blood transfusions have been separately related to worse prognosis after gastrectomy for patients with gastric cancer. This multicenter cohort study aims to evaluate their synergic effect on inflammatory activation and prognosis. 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. The analysis shows that perioperative blood transfusion and infectious complications have a synergic effect creating a pro-inflammatory activation that favors tumor recurrence. These findings reinforce the need of promoting restrictive policies of transfusion for patients undergoing gastrectomies implementing patients blood management programs. 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.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Perioperative transfusion ; Infectious complications ; Inflammatory markers ; Gastric cancer ; Gastrectomy ; Patient blood management
Publicado en:	Cancers, Vol. 15 (december 2022) , ISSN 2072-6694

DOI: 10.3390/cancers15010144
PMID: 36612141

13 p, 4.5 MB

El registro aparece en las colecciones:
Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Instituto de Investigación e Innovación Parc Taulí (I3PT)
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