Perioperative Blood Transfusion Is Dose-Dependently Associated with Cancer Recurrence and Mortality after Head and Neck Cancer Surgery

SIMPLE SUMMARY: In head and neck cancer surgery, blood transfusion is required occasionally due to patients’ underlying conditions and perioperative blood loss during surgical resection. However, transfusion is associated with immunosuppression, also known as the term “transfusion-related immune modulation (TRIM)”, which could lead to worse cancer prognoses. The purpose of the study is to assess the association between perioperative blood transfusion and head and neck cancer recurrence and mortality. Our findings showed that blood transfusion was significantly associated with both cancer recurrence and mortality after head and neck cancer surgery. ABSTRACT: Background: The association between perioperative blood transfusion and cancer prognosis in patients with head and neck cancer (HNC) receiving surgery remains controversial. Methods: We designed a retrospective observational study of patients with HNC undergoing tumor resection surgery from 2014 to 2017 and followed them up until June 2020. An inverse probability of treatment weighting (IPTW) was applied to balance baseline patient characteristics in the exposed and unexposed groups. COX regression was used for the evaluation of tumor recurrence and overall survival. Results: A total of 683 patients were included; 192 of them (28.1%) received perioperative packed RBC transfusion. Perioperative blood transfusion was significantly associated with HNC recurrence (IPTW adjusted HR: 1.37, 95% CI: 1.1–1.7, p = 0.006) and all-cause mortality (IPTW adjusted HR: 1.37, 95% CI: 1.07–1.74, p = 0.011). Otherwise, there was an increased association with cancer recurrence in a dose-dependent manner. Conclusion: Perioperative transfusion was associated with cancer recurrence and mortality after HNC tumor surgery.