title: Impact of Blood Transfusions on Survival of Locally Advanced Cervical Cancer Patients Undergoing Neoadjuvant Chemotherapy Plus Radical Surgery.
abstract: Transfusions represent one of the main progresses of modern medicine. However, accumulating evidence supports that transfusions correlate with worse survival outcomes in patients affected by solid cancers. In the present study, we aimed to investigate the effects of perioperative blood transfusion in locally advanced cervical cancer.
  
  
  
  Data of consecutive patients affected by locally advanced cervical cancer scheduled to undergo neoadjuvant chemotherapy plus radical surgery were retrospectively searched to test the impact of perioperative transfusions on survival outcomes. Five-year survival outcomes were evaluated using Kaplan-Meier and Cox models.
  
  
  
  The study included 275 patients. Overall, 170 (62%) patients had blood transfusion. Via univariate analysis, we observed that transfusion correlated with an increased risk of developing recurrence (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.09-4.40; P = 0.02). Other factors associated with 5-year disease-free survival were noncomplete clinical response after neoadjuvant chemotherapy (HR, 2.99; 95% CI, 0.92-9.63; P = 0.06) and pathological (P = 0.03) response at neoadjuvant chemotherapy as well as parametrial (P = 0.004), vaginal (P < 0.001), and lymph node (P = 0.002) involvements. However, via multivariate analysis, only vaginal (HR, 3.07; 95% CI, 1.20-7.85; P = 0.01) and lymph node involvements (HR, 2.4; 95% CI, 1.00-6.06; P = 0.05) correlate with worse disease-free survival. No association with worse outcomes was observed for patients undergoing blood transfusion (HR, 2.71; 95% CI, 0.91-8.03; P = 0.07). Looking at factors influencing overall survival, we observed that lymph node status (P = 0.01) and vaginal involvement (P = 0.06) were independently associated with survival.
  
  
  
  The role of blood transfusions in increasing the risk of developing recurrence in LAAC patients treated by neoadjuvant chemotherapy plus radical surgery remains unclear; further prospective studies are warranted.
authors.affiliation: *Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan; †Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino-IST; and ‡Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.forename: Antonino
authors.initials: A
authors.lastname: Ditto
authors.forename: Fabio
authors.initials: F
authors.lastname: Martinelli
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.forename: Valentina
authors.initials: V
authors.lastname: Chiappa
authors.forename: Carlos
authors.initials: C
authors.lastname: Lopez
authors.forename: Alice
authors.initials: A
authors.lastname: Indini
authors.forename: Umberto
authors.initials: U
authors.lastname: Leone Roberti Maggiore
authors.forename: Ilaria
authors.initials: I
authors.lastname: Sabatucci
authors.forename: Domenica
authors.initials: D
authors.lastname: Lorusso
authors.forename: Francesco
authors.initials: F
authors.lastname: Raspagliesi
mesh_terms: D017024:Chemotherapy, Adjuvant; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D019990:Perioperative Care / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy*