title: The impact of perioperative packed red blood cell transfusion on survival in epithelial ovarian cancer.
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.
authors.affiliation: *Mayo Medical School, †Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, ‡Department of Surgical Clinical Research, and §Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Lindsay L Morgenstern
authors.initials: LL
authors.lastname: Warner
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
authors.forename: Janice R
authors.initials: JR
authors.lastname: Martin
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Lemens
authors.forename: Michaela E
authors.initials: ME
authors.lastname: McGree
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: Karl C
authors.initials: KC
authors.lastname: Podratz
authors.forename: Jamie N
authors.initials: JN
authors.lastname: Bakkum-Gamez
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000401:mortality*; D000077216:Carcinoma, Ovarian Epithelial; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D059035:Perioperative Period; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis