Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 11/2019

01-11-2019 | Hepatocellular Carcinoma | Original Scientific Report

Perioperative Allogeneic Blood Transfusion Does not Influence Patient Survival After Hepatectomy for Hepatocellular Carcinoma: A Propensity Score Matching Analysis

Authors: Yo-ichi Yamashita, Hiromitsu Hayashi, Katsunori Imai, Hirohisa Okabe, Shigeki Nakagawa, Fumimasa Kitamura, Norio Uemura, Yosuke Nakao, Toshihiko Yusa, Rumi Itoyama, Takanobu Yamao, Naoki Umesaki, Tatsunori Miyata, Akira Chikamoto, Mototsugu Shimokawa, Hideo Baba

Published in: World Journal of Surgery | Issue 11/2019

Login to get access

Abstract

Background

Whether perioperative allogeneic blood transfusion (PABT) negatively influences patient survival after hepatectomy (HR) for hepatocellular carcinoma (HCC) remains controversial.

Methods

Five hundred two patients who underwent HR for initial HCC between 1994 and 2015 were enrolled in this study. All patients were divided into two groups: the PABT group and the non-PABT group. Differences of clinicopathological factors, overall survival (OS), recurrence-free survival (RFS), and the recurrence pattern between the two groups were evaluated. Using propensity score matching for tumor-related factors, liver functions, and surgical factors (total 11 factors), the survival impact of PABT was also analyzed.

Results

In the entire cohort, 78 patients (15.5%) received PABT such as red cell concentrate, fresh-frozen plasma, or platelets. OS (5-year OS: 55% vs. 76%; p = 0.0005) and RFS (2-year RFS: 47% vs. 56%; p = 0.0131) were significantly worse in the PABT group. The extrahepatic recurrence happened more frequently in the PABT group (15% vs. 5.4%; p = 0.0039). There were many significant clinicopathological differences between the two groups: more advanced tumor stage (tumor diameter, stage III or IV, microvascular invasion), worse liver functions (albumin, indocyanine green retention rate at 15 min), and more surgical stress (blood loss, operation time) in the PABT group. After propensity score matching, 43 pairs of patients were extracted. In this matched cohort, the survival curves of the PABT and non-PABT groups almost completely overlapped both in OS (5-year OS: 62% vs. 62%; p = 0.4384) and in RFS (2-year RFS: 49% vs. 47%; p = 0.8195). The significant difference of the extrahepatic recurrence rate disappeared in the matched cohort (p = 0.5789).

Conclusion

Using propensity score matching, we found that PABT does not influence patient survival after HR for HCC.
Literature
1.
Siegel R, Ma J, Zou Z, Jemal A (2014) Cancer statistics, 2014. CA Cancer J Clin 64:9–29CrossRef
2.
Yamashita YI, Imai K, Yusa T, Nakao Y, Kitano Y, Nakagawa S, Okabe H, Chikamoto A, Ishiko T, Yoshizumi T, Aishima S, Maehara Y, Baba H (2018) Microvascular invasion of single small hepatocellular carcinoma ≤ 3 cm: predictors and optimal treatments. Ann Gastroenterol Surg 2(197–203):3
3.
Bruix J, Gores GJ, Mazzaferro V (2014) Hepatocellular carcinoma: clinical frontiers and perspectives. Gut 63:844–855CrossRef
4.
Taketomi A, Kitagawa D, Itoh S, Harimoto N, Yamashita Y, Gion T, Shirabe K, Shimada M, Maehara Y (2007) Trends in morbidity and mortality after hepatic resection for hepatocellular carcinoma: an institute’s experience with 625 patients. J Am Coll Surg 204:580–587CrossRef
5.
Cescon M, Vetrone G, Grazi GL, Ramacciato G, Ercolani G, Ravaioli M, Del Gaudio M, Pinna AD (2009) Trends in perioperative outcome after hepatic resection: analysis of 1500 consecutive unselected cases over 20 years. Ann Surg 249:995–1002CrossRef
6.
Matsumata T, Ikeda Y, Hayashi H, Kamakura T, Taketomi A, Sugimachi K (1993) The association between transfusion and cancer-free survival after curative resection for hepatocellular carcinoma. Cancer 72:1866–1871CrossRef
7.
Yamamoto J, Kosuge T, Takayama T, Shimada K, Yamasaki S, Ozaki H, Yamaguchi N, Mizuno S, Makuuchi M (1994) Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery 115:303–309PubMed
8.
Fan ST, Ng IO, Poon RT, Lo CM, Liu CL, Wong J (1999) Hepatectomy for hepatocellular carcinoma: the surgeon’s role in long-term survival. Arch Surg 134:1124–1130CrossRef
9.
10.
Makino Y, Yamanoi A, Kimoto T, El-Assal ON, Kohno H, Nagasue N (2000) The influence of perioperative blood transfusion on intrahepatic recurrence after curative resection of hepatocellular carcinoma. Am J Gastroenterol 95:294–300CrossRef
11.
Hanazaki K, Kajikawa S, Shimozawa N, Matsushita A, Machida T, Shimada K, Yazawa K, Koide N, Adachi W, Amano J (2005) Perioperative blood transfusion and survival following curative hepatic resection for hepatocellular carcinoma. Hepatogastroenterology 52:524–529PubMed
12.
13.
Liu L, Wang Z, Jiang S, Shao B, Liu J, Zhang S, Zhou Y, Zhou Y, Zhang Y (2013) Perioperative allogenenic blood transfusion is associated with worse clinical outcomes for hepatocellular carcinoma: a meta-analysis. PLoS ONE 8:e64261CrossRef
14.
Xun Y, Tian H, Hu L, Yan P, Yang K, Guo T (2018) The impact of perioperative allogeneic blood transfusion on prognosis of hepatocellular carcinoma after radical hepatectomy: a systematic review and meta-analysis of cohort studies. Medicine (Baltimore) 97:e12911CrossRef
15.
Yang T, Lu JH, Lau WY, Zhang TY, Zhang H, Shen YN, Alshebeeb K, Wu MC, Schwartz M, Shen F (2016) Perioperative blood transfusion does not influence recurrence-free and overall survivals after curative resection for hepatocellular carcinoma: a Propensity Score Matching Analysis. J Hepatol 64:583–593CrossRef
16.
17.
Peng T, Zhao G, Wang L, Wu J, Cui H, Liang Y, Zhou R, Liu Z, Wang Q (2018) No impact of perioperative blood transfusion on prognosis after curative resection for hepatocellular carcinoma: a propensity score matching analysis. Clin Transl Oncol 20:719–728CrossRef
18.
Wada H, Eguchi H, Nagano H, Kubo S, Nakai T, Kaibori M, Hayashi M, Takemura S, Tanaka S, Nakata Y, Matsui K, Ishizaki M, Hirokawa F, Komeda K, Uchiyama K, Kon M, Doki Y, Mori M (2018) Perioperative allogenic blood transfusion is a poor prognostic factor after hepatocellular carcinoma surgery: a multi-center analysis. Surg Today 48:73–79CrossRef
19.
Yamashita Y, Ikeda T, Kurihara T, Yoshida Y, Takeishi K, Itoh S, Harimoto N, Kawanaka H, Shirabe K, Maehara Y (2014) Long-term favorable surgical results of laparoscopic hepatic resection for hepatocellular carcinoma in patients with cirrhosis: a single-center experience over a 10-year period. J Am Coll Surg 219:1117–1123CrossRef
20.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRef
21.
Liver Cancer Study Group of Japan (2015) The general rules for the clinical and pathological study of primary liver cancer, 6th edn, revised version. Kanehara, Tokyo
22.
Yamashita Y, Shirabe K, Tsuijita E, Takeishi K, Ikegami T, Yoshizumi T, Soejima Y, Ikeda T, Utsunomiya T, Maehara Y (2013) Third or more repeat hepatectomy for recurrent hepatocellular carcinoma. Surgery 154:1038–1045CrossRef
23.
Kanematsu T, Furuta T, Takenaka K, Matsumata T, Yoshida Y, Nishizaki T, Hasuo K, Sugimachi K (1989) A 5-year experience of lipiodolization: selective regional chemotherapy for 200 patients with hepatocellular carcinoma. Hepatology 10:98–102CrossRef
24.
Rubin DB (1997) Estimating causal effects from large data sets using propensity scores. Ann Intern Med 127:757–763CrossRef
25.
D’Agostino RB Jr (1998) Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 17:2265–2281CrossRef
26.
Franssen B, Alshebeeb K, Tabrizian P, Marti J, Pierobon ES, Lubezky N, Roayaie S, Florman S, Schwartz ME (2014) Differences in surgical outcomes between hepatitis B- and hepatitis C-related hepatocellular carcinoma: a retrospective analysis of a single North American center. Ann Surg. 260:650–656 (discussion 656–8) CrossRef
27.
Kimbrough CW, Agle SC, Scoggins CR, Martin RC, Marvin MR, Davis EG, McMasters KM, Jones CM (2014) Factors predictive of readmission after hepatic resection for hepatocellular carcinoma. Surgery 156:1039–1046CrossRef
28.
Aloia TA, Fahy BN, Fischer CP, Jones SL, Duchini A, Galati J, Gaber AO, Ghobrial RM, Bass BL (2009) Predicting poor outcome following hepatectomy: analysis of 2313 hepatectomies in the NSQIP database. HPB (Oxford) 11:510–515CrossRef
29.
Ishizawa T, Hasegawa K, Aoki T, Takahashi M, Inoue Y, Sano K, Imamura H, Sugawara Y, Kokudo N, Makuuchi M (2008) Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology 134:1908–1916CrossRef
30.
Yamashita YI, Imai K, Kaida T, Yamao T, Tsukamoto M, Nakagawa S, Okabe H, Chikamoto A, Ishiko T, Yoshizumi T, Ikeda T, Maehara Y, Baba H (2019) Multimodal radiofrequency ablation versus laparoscopic hepatic resection for the treatment of primary hepatocellular carcinoma within Milan criteria in severely cirrhotic patients: long-term favorable outcomes over 10 years. Surg Endosc 33:46–51CrossRef
31.
Brunson ME, Alexander JW (1990) Mechanisms of transfusion-induced immunosuppression. Transfusion 30:651–658CrossRef
32.
Blajchman MA (1998) Immunomodulatory effects of allogeneic blood transfusions: clinical manifestations and mechanisms. Vox Sang 74(Suppl 2):315–319CrossRef
33.
Vamvakas EC, Blajchman MA (2007) Transfusion-related immunomodulation (TRIM): an update. Blood Rev 21:327–348CrossRef
34.
35.
Chen G, Zhang FJ, Gong M, Yan M (2007) Effect of perioperative autologous versus allogeneic blood transfusion on the immune system in gastric cancer patients. J Zhejiang Univ Sci B 8:560–565CrossRef
36.
Ghio M, Contini P, Mazzei C, Brenci S, Barberis G, Filaci G, Indiveri F, Puppo F (1999) Soluble HLA class I, HLA class II, and Fas ligand in blood components: a possible key to explain the immunomodulatory effects of allogeneic blood transfusions. Blood 93:1770–1777PubMed
37.
Puppo F, Ghio M, Contini P, Mazzei C, Indiveri F (2001) Fas, Fas ligand, and transfusion immunomodulation. Transfusion 41:416–418CrossRef
38.
Kriebardis A, Antonelou M, Stamoulis K, Papassideri I (2012) Cell-derived microparticles in stored blood products: Innocent-bystanders or effective mediators of post-transfusion reactions? Blood Transfus 10(Suppl 2):s25–s38PubMedPubMedCentral
39.
Procter LD, Meier CF, Hamilton C, Gerughty AR, Overall P, Santapuram P, Davenport DL, McNamara P, Woodward J, Bernard AC (2013) y + cationic amino acid transport of arginine in packed red blood cells. J Surg Res 179:e183–e187CrossRef
40.
Yamashita Y, Shirabe K, Aishima S, Maehara Y (2015) Predictors of microvascular invasion in hepatocellular carcinoma. Dig Dis 33:655–660CrossRef
41.
Iguchi T, Shirabe K, Aishima S, Wang H, Fujita N, Ninomiya M, Yamashita Y, Ikegami T, Uchiyama H, Yoshizumi T, Oda Y, Maehara Y (2015) New pathologic stratification of microvascular invasion in hepatocellular carcinoma: predicting prognosis after living-donor liver transplantation. Transplantation 99:1236–1242CrossRef
42.
Omata M, Cheng AL, Kokudo N, Kudo M, Lee JM, Jia J, Tateishi R, Han KH, Chawla YK, Shiina S, Jafri W, Payawal DA, Ohki T, Ogasawara S, Chen PJ, Lesmana CRA, Lesmana LA, Gani RA, Obi S, Dokmeci AK, Sarin SK (2017) Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int 11:317–370CrossRef
43.
Katz SC, Shia J, Liau KH, Gonen M, Ruo L, Jarnagin WR, Fong Y, D’Angelica MI, Blumgart LH, Dematteo RP (2009) Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg 249:617–623CrossRef
44.
Marcucci C, Madjdpour C, Spahn DR (2004) Allogeneic blood transfusions: benefit, risks and clinical indications in countries with a low or high human development index. Br Med Bull 70:15–28CrossRef
45.
Domen RE, Hoeltge GA (2003) Allergic transfusion reactions: an evaluation of 273 consecutive reactions. Arch Pathol Lab Med 127:316–320PubMed
Metadata
Title
Perioperative Allogeneic Blood Transfusion Does not Influence Patient Survival After Hepatectomy for Hepatocellular Carcinoma: A Propensity Score Matching Analysis
Authors
Yo-ichi Yamashita
Hiromitsu Hayashi
Katsunori Imai
Hirohisa Okabe
Shigeki Nakagawa
Fumimasa Kitamura
Norio Uemura
Yosuke Nakao
Toshihiko Yusa
Rumi Itoyama
Takanobu Yamao
Naoki Umesaki
Tatsunori Miyata
Akira Chikamoto
Mototsugu Shimokawa
Hideo Baba
Publication date
01-11-2019
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 11/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-019-05085-w

Other articles of this Issue 11/2019

World Journal of Surgery 11/2019 Go to the issue

Invited Commentary

Invited Commentary Re: Early Chemical Thromboprophylaxis does not Increase the Risk of Intracranial Hematoma Progression in Patients with Isolated Severe Traumatic Brain Injury

Original Scientific Report

Early Chemical Thromboprophylaxis Does not Increase the Risk of Intracranial Hematoma Progression in Patients with Isolated Severe Traumatic Brain Injury

Original Scientific Report

Influence of Daily Variations in Individual Surgeon’s Operative Time on Patient Outcomes

Correction

Correction to: An Acute General Surgical Unit (AGSU) Negates the Impact of the Tokyo Guidelines 2018 (TG18) Diagnostic Criteria for the Treatment of Acute Cholecystitis

Original Scientific Report

Predictors of Death in Necrotizing Skin and Soft Tissue Infection

Original Scientific Report

Impact of Timeliness of Surgical Treatment on the Outcomes of Patients with Non-metastatic Non-small Cell Lung Cancer: Findings From the PLCO Trial