The impact of perioperative packed red blood cell transfusion on survival in epithelial ovarian cancer

Lindsay L Morgenstern Warner, Sean Christopher Dowdy, Janice R. Martin, Maureen A. Lemens, Michaela E. McGree, Amy L. Weaver, Karl C. Podratz, Jamie N Bakkum-Gamez

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: Perioperative packed red blood cell transfusion (PRBCT) has been implicated as a negative prognostic marker in surgical oncology. There is a paucity of evidence on the impact of PRBCT on outcomes in epithelial ovarian cancer (EOC). We assessed whether PRBCT is an independent risk factor of recurrence and death from EOC. Methods: Perioperative patient characteristics and process-of-care variables (defined by the National Surgical Quality Improvement Program) were retrospectively abstracted from 587 women who underwent primary EOC staging between January 2, 2003, and December 29, 2008. Associations with receipt of PRBCT were evaluated using univariate logistic regression models. The associations between receipt of PRBCT and disease-free survival and overall survival were evaluated using multivariable Cox proportional hazards models and using propensity score matching and stratification, respectively. Results: The rate of PRBCT was 77.0%. The mean ± SD units transfused was 4.1 ± 3.1 U. In the univariate analysis, receipt of PRBCT was significantly associated with older age, advanced stage (≥IIIA), undergoing splenectomy, higher surgical complexity, serous histologic diagnosis, greater estimated blood loss, longer operating time, the presence of residual disease, and lower preoperative albumin and hemoglobin. Perioperative packed red blood cell transfusion was not associated with an increased risk for recurrence or death, in an analysis adjusting for other risk factors in a multivariable model or in an analysis using propensity score matching or stratification to control for differences between the patients with and without PRBCT. Conclusions: Perioperative packed red blood cell transfusion does not seem to be directly associated with recurrence and death in EOC. However, lower preoperative hemoglobin was associated with a higher risk for recurrence. The need for PRBCT seems to be a stronger prognostic indicator than the receipt of PRBCT.

Original languageEnglish (US)
Pages (from-to)1612-1619
Number of pages8
JournalInternational Journal of Gynecological Cancer
Volume23
Issue number9
DOIs
StatePublished - 2013

Fingerprint

Erythrocyte Transfusion
Survival
Recurrence
Propensity Score
Ovarian epithelial cancer
Hemoglobins
Logistic Models
Hematologic Diseases
Neoplasm Staging
Splenectomy
Quality Improvement
Proportional Hazards Models
Disease-Free Survival
Albumins

Keywords

  • Disease-free survival
  • Ovarian cancer
  • Overall survival
  • Perioperative red blood cell transfusion

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

The impact of perioperative packed red blood cell transfusion on survival in epithelial ovarian cancer. / Warner, Lindsay L Morgenstern; Dowdy, Sean Christopher; Martin, Janice R.; Lemens, Maureen A.; McGree, Michaela E.; Weaver, Amy L.; Podratz, Karl C.; Bakkum-Gamez, Jamie N.

In: International Journal of Gynecological Cancer, Vol. 23, No. 9, 2013, p. 1612-1619.

Research output: Contribution to journalArticle

Warner, Lindsay L Morgenstern ; Dowdy, Sean Christopher ; Martin, Janice R. ; Lemens, Maureen A. ; McGree, Michaela E. ; Weaver, Amy L. ; Podratz, Karl C. ; Bakkum-Gamez, Jamie N. / The impact of perioperative packed red blood cell transfusion on survival in epithelial ovarian cancer. In: International Journal of Gynecological Cancer. 2013 ; Vol. 23, No. 9. pp. 1612-1619.
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abstract = "Objective: Perioperative packed red blood cell transfusion (PRBCT) has been implicated as a negative prognostic marker in surgical oncology. There is a paucity of evidence on the impact of PRBCT on outcomes in epithelial ovarian cancer (EOC). We assessed whether PRBCT is an independent risk factor of recurrence and death from EOC. Methods: Perioperative patient characteristics and process-of-care variables (defined by the National Surgical Quality Improvement Program) were retrospectively abstracted from 587 women who underwent primary EOC staging between January 2, 2003, and December 29, 2008. Associations with receipt of PRBCT were evaluated using univariate logistic regression models. The associations between receipt of PRBCT and disease-free survival and overall survival were evaluated using multivariable Cox proportional hazards models and using propensity score matching and stratification, respectively. Results: The rate of PRBCT was 77.0{\%}. The mean ± SD units transfused was 4.1 ± 3.1 U. In the univariate analysis, receipt of PRBCT was significantly associated with older age, advanced stage (≥IIIA), undergoing splenectomy, higher surgical complexity, serous histologic diagnosis, greater estimated blood loss, longer operating time, the presence of residual disease, and lower preoperative albumin and hemoglobin. Perioperative packed red blood cell transfusion was not associated with an increased risk for recurrence or death, in an analysis adjusting for other risk factors in a multivariable model or in an analysis using propensity score matching or stratification to control for differences between the patients with and without PRBCT. Conclusions: Perioperative packed red blood cell transfusion does not seem to be directly associated with recurrence and death in EOC. However, lower preoperative hemoglobin was associated with a higher risk for recurrence. The need for PRBCT seems to be a stronger prognostic indicator than the receipt of PRBCT.",
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T1 - The impact of perioperative packed red blood cell transfusion on survival in epithelial ovarian cancer

AU - Warner, Lindsay L Morgenstern

AU - Dowdy, Sean Christopher

AU - Martin, Janice R.

AU - Lemens, Maureen A.

AU - McGree, Michaela E.

AU - Weaver, Amy L.

AU - Podratz, Karl C.

AU - Bakkum-Gamez, Jamie N

PY - 2013

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N2 - Objective: Perioperative packed red blood cell transfusion (PRBCT) has been implicated as a negative prognostic marker in surgical oncology. There is a paucity of evidence on the impact of PRBCT on outcomes in epithelial ovarian cancer (EOC). We assessed whether PRBCT is an independent risk factor of recurrence and death from EOC. Methods: Perioperative patient characteristics and process-of-care variables (defined by the National Surgical Quality Improvement Program) were retrospectively abstracted from 587 women who underwent primary EOC staging between January 2, 2003, and December 29, 2008. Associations with receipt of PRBCT were evaluated using univariate logistic regression models. The associations between receipt of PRBCT and disease-free survival and overall survival were evaluated using multivariable Cox proportional hazards models and using propensity score matching and stratification, respectively. Results: The rate of PRBCT was 77.0%. The mean ± SD units transfused was 4.1 ± 3.1 U. In the univariate analysis, receipt of PRBCT was significantly associated with older age, advanced stage (≥IIIA), undergoing splenectomy, higher surgical complexity, serous histologic diagnosis, greater estimated blood loss, longer operating time, the presence of residual disease, and lower preoperative albumin and hemoglobin. Perioperative packed red blood cell transfusion was not associated with an increased risk for recurrence or death, in an analysis adjusting for other risk factors in a multivariable model or in an analysis using propensity score matching or stratification to control for differences between the patients with and without PRBCT. Conclusions: Perioperative packed red blood cell transfusion does not seem to be directly associated with recurrence and death in EOC. However, lower preoperative hemoglobin was associated with a higher risk for recurrence. The need for PRBCT seems to be a stronger prognostic indicator than the receipt of PRBCT.

AB - Objective: Perioperative packed red blood cell transfusion (PRBCT) has been implicated as a negative prognostic marker in surgical oncology. There is a paucity of evidence on the impact of PRBCT on outcomes in epithelial ovarian cancer (EOC). We assessed whether PRBCT is an independent risk factor of recurrence and death from EOC. Methods: Perioperative patient characteristics and process-of-care variables (defined by the National Surgical Quality Improvement Program) were retrospectively abstracted from 587 women who underwent primary EOC staging between January 2, 2003, and December 29, 2008. Associations with receipt of PRBCT were evaluated using univariate logistic regression models. The associations between receipt of PRBCT and disease-free survival and overall survival were evaluated using multivariable Cox proportional hazards models and using propensity score matching and stratification, respectively. Results: The rate of PRBCT was 77.0%. The mean ± SD units transfused was 4.1 ± 3.1 U. In the univariate analysis, receipt of PRBCT was significantly associated with older age, advanced stage (≥IIIA), undergoing splenectomy, higher surgical complexity, serous histologic diagnosis, greater estimated blood loss, longer operating time, the presence of residual disease, and lower preoperative albumin and hemoglobin. Perioperative packed red blood cell transfusion was not associated with an increased risk for recurrence or death, in an analysis adjusting for other risk factors in a multivariable model or in an analysis using propensity score matching or stratification to control for differences between the patients with and without PRBCT. Conclusions: Perioperative packed red blood cell transfusion does not seem to be directly associated with recurrence and death in EOC. However, lower preoperative hemoglobin was associated with a higher risk for recurrence. The need for PRBCT seems to be a stronger prognostic indicator than the receipt of PRBCT.

KW - Disease-free survival

KW - Ovarian cancer

KW - Overall survival

KW - Perioperative red blood cell transfusion

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