title: Preoperative anemia, blood transfusion, and neutrophil-to-lymphocyte ratio in patients with stage i non-small cell lung cancer.
abstract: Perioperative and postoperative blood transfusions (BT), anemia and inflammation are associated with poor survivals in patients with non-small cell lung cancer (NSCLC). This study investigated the impact of perioperative BT on the survival of patients with NSCLC taking into account their preoperative inflammatory status and the presence of anemia. Demographic, perioperative, and survival data for 861 patients with stage I NSCLC was collected retrospectively. The primary endpoints of interest were recurrence-free (RFS) and overall survival (OS). Before and after propensity score matching, univariate and multivariable Cox proportional hazards models were used to evaluate the association between covariates and survival. A neutrophil-to-lymphocyte ratio (NLR) < 5 (hazard ratio [HR]: 0.58, 95% CI: 0.38-0.87;p= 0.009) and normal Hb concentration (HR: 0.72, 95% CI: 0.72;p= 0.022) were independently associated with longer RFS. The administration of blood perioperatively was associated with a trend towards worse RFS (HR: 0.69, 95% CI: 0.47-1.02;p= 0.066). The multivariate analysis also revealed that an NLR < 5 (HR: 0.48, 95% CI: 0.3-0.76;p= 0.001) and the absence of BT (HR: 0.63, 95% CI: 0.4-0.98;p= 0.04) were significantly associated with lower mortality risk. The propensity score matching analysis did not confirm the association between BT and poor RFS (HR: 0.63, 95% CI: 0.35-1.1;p= 0.108) and OS (HR: 0.52, 95% CI: 0.26-1.04;p= 0.06). Inflammation and anemia are common finding in patients with stage 1 NSCLC. After adjusting for these two important confounders, this study confirms that previous reports demonstrating an association between BT and poor survival after NSCLC surgery.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Anesthesia and Surgical Oncology Research Group, Houston, Texas, USA.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Cata
authors.affiliation: Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gutierrez
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Reza J
authors.initials: RJ
authors.lastname: Mehran
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: David
authors.initials: D
authors.lastname: Rice
authors.affiliation: Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Nates
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rodriguez-Restrepo
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Martinez
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Anesthesia and Surgical Oncology Research Group, Houston, Texas, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Mena
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Vijaya
authors.initials: V
authors.lastname: Gottumukkala
keywords: Non-small cell; anemia; blood transfusions; cancer recurrence; survival