Institutional members access full text with Ovid®

Blood Transfusions and Prognosis in Colorectal Cancer: Long-Term Results of a Randomized Controlled Trial

Harlaar, Joris J. MD*; Gosselink, Martijn P. MD, PhD*; Hop, Wim C. J. PhD; Lange, Johan F. MD, PhD*; Busch, Olivier R. C. MD, PhD§; Jeekel, Hans MD, PhD

doi: 10.1097/SLA.0b013e318271cedf
Original Articles From the ESA Proceedings

Objective: Perioperative blood transfusions may adversely affect survival in patients with colorectal malignancy, although definite proof of a causal relationship has never been reported.

Background: We report the long-term outcomes of a randomized controlled trial performed between 1986 and 1991 to compare the effects of allogeneic blood transfusions and an autologous blood transfusion program in colorectal cancer patients.

Methods: All 475 randomized patients operated upon for colorectal cancer were tracked via a national computerized record-linkage system to investigate survival and cause of death. Kaplan-Meier survival curves were constructed and multivariate Cox regression analysis was performed to study 20 years' overall survival. Colorectal cancer-specific survival was analyzed over the 10-year time period after surgery.

Results: The overall survival percentage at 20 years after surgery was worse in the autologous group (21%) compared to the allogeneic group (28%) (P = 0.041; log-rank test). Cox regression, allowing for tumor stage, age, and sex, resulted in a hazard ratio (autologous vs allogeneic group) for overall mortality of 1.24 (95% confidence interval 1.00–1.54; P = 0.051). Colorectal cancer-specific survival at 10 years for the whole study group was 48% and 60% for the autologous and allogeneic group, respectively (P = 0.020; log-rank test). The adjusted hazard ratio was 1.39 (95 confidence interval 1.05–1.83; P = 0.045).

Conclusions: At long-term follow-up colorectal cancer patients did not benefit from autologous transfusion compared with standard allogeneic transfusion. On the contrary, the overall and colorectal cancer-specific survival rates were worse in the patients in the autologous transfusion group.

We report the long-term outcomes of a randomized controlled trial performed between 1986 and 1991 to compare the effects of allogeneic blood transfusions and an autologous blood transfusion program in colorectal cancer patients. Kaplan-Meier survival curves were constructed and multivariate Cox regression analysis was performed to study 20 years' overall survival. Colorectal cancer-specific survival at 10 years for the whole study group was 48% and 60% for the autologous and allogeneic group, respectively P = 0.020; log-rank test).

*Department of Surgery

Department of Biostatistics

Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands

§Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.

Reprints: Joris J. Harlaar, Department of Surgery, Erasmus University Medical Center, Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands. E-mail: j.harlaar@erasmusmc.nl.

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.