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The Effects of Anemia and Blood Transfusion on Patients With Stage III-IV Ovarian Cancer

Altman, Alon D. MD, FRCSC*; Liu, Xiao-Qing MD, MSc*†; Nelson, Gregg MD, PhD, FRCSC; Chu, Pamela MD, MBA, FRCSC; Nation, Jill MD, FRCSC; Ghatage, Prafull MBChB, FRCSC, FACOG

International Journal of Gynecological Cancer: November 2013 - Volume 23 - Issue 9 - p 1569–1576
doi: 10.1097/IGC.0b013e3182a57ff6
Ovarian Cancer

Objectives The objective of this study was to examine the overall and recurrence-free survival in patients with advanced ovarian cancer based on hemoglobin and blood transfusions.

Methods A retrospective chart review was performed between 2003 and 2007 on patients with pathologically confirmed stage 3–4 ovarian, fallopian, or peritoneal cancers. Data were collected on date of diagnosis, recurrence and death, stage, grade, age, surgery, estimated blood loss, hemoglobin (nadir and average levels), and number of blood transfusions.

Results Two hundred sixteen patients were included in the final analysis. In the perichemotherapy, perioperative, and total time frames, 88%, 81%, and 95% of patients were anemic, and 9%, 22%, and 26% of the patients had severe anemia. After adjusting for age, stage, and optimal debulking status, the perichemotherapy hemoglobin level as a continuous variable was weakly associated with recurrence-free survival (adjusted hazard ratio [AHR], 0.98; P = 0.03), and as a categorical variable with both recurrence-free survival (AHR, 2.49; P = 0.003) and overall survival (AHR, 1.91; P = 0.02). The total number of transfusions was also weakly associated with poor recurrence-free survival (AHR, 1.06; P = 0.03).

Conclusions Our study is a retrospective analysis of the effects of anemia and transfusion on ovarian cancer. The rates of anemia in chemotherapy patients are higher than previously reported. Although maintaining average hemoglobin greater than 80 g/L during chemotherapy portends an improved overall survival, blood transfusion does not have any effect. The role of transfusion should therefore be limited to symptomatic patients while giving 1 unit at a time. Further prospective studies will be needed to confirm these results.

*Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Winnipeg Health Sciences Centre & CancerCare Manitoba; and †Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba; and ‡Tom Baker Cancer Centre & Foothills Medical Centre and Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada.

Address correspondence and reprint requests to Alon D. Altman, MD, FRCSC, RS 406, 810 Sherbrook St, Winnipeg, Manitoba, Canada R3A 1R9. E-mail:

The authors declare no conflicts of interest.

Received May 5, 2013

Accepted July 17, 2013

© 2013 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.