The significance of allogeneic blood transfusion in the prognosis of patients with non small lung cancer (NSCLC) remains controversial. There are reports to suggest that patients with adenocarcinoma (AdenoCa) have a worse prognosis from cancer than patients with squamous cell carcinoma (SCC) but this evidence is lacking in NSCLC. The objective of the current study was to elucidate the correlation between peri-operative allogeneic blood transfusion and the prognosis in patients with AdenoCa and SCC.
The study group compromised 329 consecutive patients (172 men and 157 women) with a mean age of 67 years who underwent lung resection between 1996 and 2003 in one unit. The clinico-pathological data and survival were compared between 62 patients (42.7%) with AdenoCa and 58 (48.3%) with Sq Cell Ca who received an peri-operative blood transfusion and 83 (57.3 %) with AdenoCa and 126 (61.3%) patients who did not.
The overall operative mortality was 3.9% (13 deaths). Median operative blood loss was 380 mL (range, 125 to 4,500 mL). Mean blood transfusion was 1.9 units (range, 0 to 8 units). Overall actuarial 1-, 3- and 5 year survival rates in the AdenoCa and Sq Cell Ca groups were 82.3%, 49.6% and 19.4% and 87.9%, 71.7%, 32.7% respectively (p=0.021). Multivariate analysis demonstrated that the factors that appeared to independently to determine prognosis in both groups were T-stage (p<0.001), lymph node metastasis (p<0.001) and post-operative complications (p=0.029). Peri-operative blood transfusion was not found to be an independent prognostic indicator in either group.
This study demonstrates that late survival in patients with adenocarcinoma of the lung is significantly worse than squamous cell carcinoma but is independent of allogeneic peri-operative blood transfusion but re-affirms the importance of tumour invasion and lymph node involvement in the overall poor prognosis of these patients.
Pulmonary adenocarcinoma appears to be associated with a poorer long term survival in early stage lung cancer. There is no correlation with blood transfusion to explain this disparity.
S. Ghosh, None.