title: Prognostic impact of blood transfusion in patients undergoing primary surgery and free-flap reconstruction for oral squamous cell carcinoma.
abstract: BACKGROUND
  The objective of this study was to assess the impact of perioperative transfusion on the prognosis of patients who underwent complete (R0) resection of oral squamous cell carcinoma and reconstruction by microvascular flaps.
  
  
  METHODS
  By following an inclusion and exclusion protocol, 223 patients were included in the study who underwent R0 resection of oral squamous cell carcinoma and reconstruction by microvascular flaps at a single center. Clinical and pathologic factors as well as transfusion data were retrieved from a prospective database and analyzed retrospectively. Survival data were assessed using the method of Kaplan and Meier. For multivariate analysis the accelerated failure time model (Weibull distribution) was chosen.
  
  
  RESULTS
  The overall survival rate was 71% at 1 year, 67% at 3 years, and 55% at 5 years. In univariate analysis, age (P = .003), tumor size (P = .005), lymph node status (P = .008), tumor differentiation (P = .008), transfusion (P = .006), American Society of Anesthesiologists (ASA) class (P = .001), and mandibular reconstruction (P = .045) were associated significantly with overall survival. Multivariate analysis identified only age, histopathologic differentiation, and ASA class as independent risk factors (P < .001, P = .04, and P = .049, respectively). Age was identified as the strongest independent predictor for overall survival (hazards ratio for each 13-year increase in age, 1.97; 95% confidence interval, 1.36-2.85).
  
  
  CONCLUSIONS
  Transfusion of >4 U of blood did not appear to influence overall survival in patients who underwent primary surgery for oral squamous cell carcinoma. Because age and ASA class evolved as the strongest predictors of shortened overall survival, associated comorbidities may require more attention, particularly in elderly or socially deprived patients.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany. matthias.fenner@mkg.imed.uni-erlangen.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Fenner
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Vairaktaris
authors.forename: Emeka
authors.initials: E
authors.lastname: Nkenke
authors.forename: Volker
authors.initials: V
authors.lastname: Weisbach
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Neukam
authors.forename: Martin
authors.initials: M
authors.lastname: Radespiel-Tröger
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000601:surgery* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery* / Q000628:therapy*; D011379:Prognosis; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps; D016019:Survival Analysis; D065227:Transfusion Reaction; D016896:Treatment Outcome