Prognostic significance of blood transfusion and anaemia on survival in stage IIIA/B/C and IVA oesophageal cancers treated with chemoradiotherapy

Objective To evaluate the prognostic effect of blood transfusion (BT) on survival outcomes in patients with stage IIIA/B/C and IVA oesophageal cancers treated with induction chemotherapy and chemoradiotherapy (C → CRT). Methods The medical records of patients with oesophageal cancer treated with C → CRT at the Royal Marsden Hospital, U.K. between 2000 and 2007 were identified and reviewed retrospectively. Patients had weekly haemoglobin measurements and received BT to maintain haemoglobin at the level of 12 g/dL and above as per the institutional policy. Overall survival (OS), progression-free survival (PFS) and locoregional recurrence-free survival (LRFS) were estimated by the Kaplan-Meier method. Cox proportional hazards regression models were used to determine the effect of anaemic and transfusion status on survival outcomes after adjusting for selected prognostic characteristics. Results Among 151 stage IIIA/B/C and IVA patients, the two-year rates for OS (53 and 53 vs. 27 %), PFS (36 and 29 vs. 22 %) and LRFS (57 and 59 vs. 43 %) were higher in those who were not anaemic and those who were anaemic with transfusion vs. those who were anaemic without transfusion, respectively. At multivariate analysis, anaemic patients who received blood transfusion had significantly lower risk of death (hazard ratios (HR) = 0.41, 95 % CI 0.23–0.74, p = 0.003), progression (HR = 0.46, 95 % CI 0.25–0.84, p = 0.009) and locoregional relapse (HR = 0.38, 95 % CI 0.16–0.89, p = 0.025) vs. those who did not. Conclusion With these current data, there was a significant benefit of BT in stage IIIA/B/C and IVA oesophageal cancers treated with chemoradiation.