Association between blood transfusion and survival in a randomised multicentre trial of perioperative adjuvant portal chemotherapy in patients with colorectal cancer

Objective: To assess the prognosis associated with blood transfusion alone and in combination with adjuvant perioperative chemotherapy in patients with colorectal cancer. Design: Univariate and multivariate retrospective analyses of survival associated with blood transfusion in patients who had taken part in a randomised multicentre trial (SAKK 40/81). Setting: Swiss Group for Clinical Cancer Research (SAKK). Subjects: 450 patients, 104 of whom (23%) did not have a blood transfusion and 346 of whom (77%) did. Interventions: Resection of colorectal cancer and portal infusion of adjuvant chemotherapy. Main outcome measures: Disease-free and overall survival. Results: The median follow-up was 9 years, and patients who had received transfusions had significantly shorter disease-free survival time (hazard ratio (HR) = 1.60; 95% CI 1.12 to 2.38). The transfusion of more than 4 units of blood products was associated with a significantly higher risk (HR = 2.52; 95% CI 1.43 to 4.44). Patients who had no transfusion and who had been assigned to have portal infusion of chemotherapy had a significantly longer disease-free survival time than patients who had transfusion but no chemotherapy (HR = 0.38; 95% CI 0.19 to 0.77). Conclusions: There was an adverse association between blood transfusion and disease-free survival. Patients given perioperative intraportal chemotherapy but no transfusion had the best disease-free survival. We recommend restricting the use of blood transfusions in patients with colorectal cancer.