title: Leukocyte depletion in allogeneic blood transfusion does not change the negative influence on survival following transthoracic resection for esophageal cancer.
abstract: BACKGROUND
  Perioperative transfusion of allogeneic blood has been hypothesized to have an immunomodulatory effect and influence survival in several cancer types. This study evaluates the association between receipt of leucocyte-depleted and non-depleted allogeneic blood and survival following esophagectomy for cancer.
  
  
  METHODS
  A retrospective analysis was performed including 291 patients with esophageal cancers who underwent transthoracic en bloc esophagectomy and extended mediastinal lymphadenectomy. Neoadjuvant chemoradiation was administered in 152 (52.2%) patients. Perioperative blood transfusions were quantified and the potential prognostic cutoff for transfused units was calculated according to LeBlanc.
  
  
  RESULTS
  The median number of perioperative blood transfusions was 2 (0-24), and 106 patients (36.4%) received no transfusions. Patients with one or less blood transfusion showed a significantly improved survival compared to patients receiving more than one unit (p < 0.009). In multivariate analysis, blood transfusion categories showed significance (p < 0.015) next to pT, pN, pM category, and residual tumor categories (R-categories). Separate analysis of 183 patients treated after the mandatory introduction of leukocyte-depleted blood transfusions detected a strong tendency, but no significant difference in survival for patients getting one or less or more than one transfusion (p = 0.056). Receipt of leukocyte-depleted versus non-depleted units, however, had no influence on survival (p = 0.766).
  
  
  CONCLUSIONS
  The need for perioperative allogeneic blood transfusions is significantly associated with poorer survival following resection for esophageal cancer by univariate and multivariate analysis. Our data suggest that the reduction of leukocytes in allogeneic transfusions is not sufficient to overcome the negative influence on survival.
authors.affiliation: Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany.
authors.forename: Frederike C
authors.initials: FC
authors.lastname: Ling
authors.forename: Arnulf H
authors.initials: AH
authors.lastname: Hoelscher
authors.forename: Daniel
authors.initials: D
authors.lastname: Vallböhmer
authors.forename: Daniel
authors.initials: D
authors.lastname: Schmidt
authors.forename: Susanne
authors.initials: S
authors.lastname: Picker
authors.forename: Birgit S
authors.initials: BS
authors.lastname: Gathof
authors.forename: Elfriede
authors.initials: E
authors.lastname: Bollschweiler
authors.forename: Paul M
authors.initials: PM
authors.lastname: Schneider
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D047589:Leukocyte Reduction Procedures; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D055815:Young Adult