title: Prognostic influence of blood transfusion on minimal residual disease in resected gastric cancer patients.
abstract: BACKGROUND
  The effect of blood transfusion on prognosis of resected cancer patients has been debated controversially. Therefore, we raised the hypothesis that transfusion-associated immunomodulation affects minimal residual disease after curative tumour resection, an unknown and uncontrolled phenomenon in all former studies which might significantly influence long-term prognosis.
  
  
  METHODS
  104 patients of a prospective study with curatively resected gastric cancer were stratified according to the immunocytochemical detection of disseminated tumour cells in bone marrow and the prognostic impact of allogeneic blood transfusion was tested. Multiple sequential bone marrow aspirations during follow-up were performed in 74 patients to investigate the blood transfusion effect on long-term development of this systemic disease component.
  
  
  RESULTS
  Whereas in patients with tumour cell detection in bone marrow a significant association of blood transfusion and survival was seen (P = 0.048; relative risk 2.91; 95% CI 1.51-5.61), this was not found in patients without disseminated tumour cells (P = 0.129). Quantitative development of tumour cells in bone marrow during follow-up demonstrated a significant quantitative increase of tumour cells in transfused patients only (P = 0.028).
  
  
  CONCLUSIONS
  These findings might explain the contradictory results of recent studies and suggest that the prognostic effect of transfusion is mediated through an impact on minimal residual disease in resected cancer patients.
authors.affiliation: Department of Surgery, Klinikum Grosshadern Ludwig-Maximilians-University, Munich, Germany.
authors.forename: M M
authors.initials: MM
authors.lastname: Heiss
authors.forename: H
authors.initials: H
authors.lastname: Allgayer
authors.forename: K U
authors.initials: KU
authors.lastname: Gruetzner
authors.forename: A
authors.initials: A
authors.lastname: Tarabichi
authors.forename: R
authors.initials: R
authors.lastname: Babic
authors.forename: W
authors.initials: W
authors.lastname: Mempel
authors.forename: K W
authors.initials: KW
authors.lastname: Jauch
authors.forename: F W
authors.initials: FW
authors.lastname: Schildberg
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D001853:Bone Marrow / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018365:Neoplasm, Residual / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis