Blood transfusion might not be recommended for gastric cancer patients with pretransfusion minimum hemoglobin values higher than 90 g/L: a real-world study covering 20 years of 13470 patients

Background: There was no consistent evidence of whether perioperative blood transfusion (PBT) affects the long-term survival of gastric cancer (GC) patients after undergoing gastrectomy. This study aimed to investigate the effects of PBT on the long-term survival of GC patients, as well as to determine the threshold of PBT and provide evidence for future surgical practice. Methods: We performed this real-world study of GC patients undergoing gastrectomy at China National Cancer Center from January 1, 2000 to December 30, 2019. Overall survival (OS) curves were plotted using the Kaplan–Meier method and compared statistically using the log-rank test. Univariate and multivariate Cox proportional hazard models were used to determine the risk factors for OS. Results: In total, 13 470 GC patients undergoing gastrectomy from 2000 to 2019 were included, of whom 3465 (34.6%) GC patients received PBT. PBT ratios declined from 29.1% (114/392) in 2000 to 11.2% in 2019 (149/1178), with the highest blood transfusion ratio in 2005 at 43.7% (220/504). For patients transfused with red blood cells, the median value of hemoglobin (Hb) before transfusion in the PBT group decreased from 110 g/l in 2000 to 87 g/l in 2019. Compared with patients who not receiving PBT, PBT group are more likely to be older (≥65, 39.1% vs. 30.1%, P <0.001), open operation (89.7% vs. 78.1%, P <0.001), higher American Society of Anesthesiologists score (>2, 25.3% vs. 14.9%, P <0.001) and in the later pTNM stage (pTNM stage III, 68.5% vs. 51.5%, P <0.001). Results of multivariable Cox regression analysis showed that PBT was an independent prognostic factor for worse OS in GC patients undergoing gastrectomy [HR=1.106, 95% confidence interval (CI): 1.01–1.211, P =0.03). After stratified according to tumor stage, we found that PBT group had a worse prognosis only in pTNM stage III (HR=1.197, 95% CI: 1.119–1.281, P <0.001). OS was obviously poor in the PBT group when Hb levels were higher than 90 g/l (90 g/l<Hb≤120 g/l: HR=1.196, 95% CI: 1.090–1.313, P <0.001; Hb>120 g/l: HR=1.207, 95% CI: 1.098–1.327, P <0.001), while there was no difference between the two groups when Hb levels were lower than or equal to 90 g/l (Hb≤90 g/l: HR=1.162, 95% CI: 0.985–1.370, P =0.075). Conclusion: In conclusion, PBT was an independent prognostic factor for worse OS. Blood transfusion might not be recommended for GC patients with perioperative minimum Hb values higher than 90 g/l.