Risk factors for blood transfusion and its prognostic implications in curative gastrectomy for gastric cancer

Table 1 Clinical characteristics of patients according to perioperative red blood cell transfusion

Variable	Non-transfusion	Red blood cell transfusion	P value
	n = 529 (%)	n = 189 (%)
Sex			0.318
Female	215 (40.6)	69 (36.5)
Male	314 (59.4)	120 (63.5)
Age (yr), mean ± SD	61.3 ± 12.4	65.6 ± 11.6	< 0.001
Body mass index (kg/m²), mean ± SD	24.6 ± 4.6	23.7 ± 11.6	0.019
Hemoglobin (g/dL), mean ± SD	12.5 ± 2.1	10.8 ± 2.2	< 0.001
Albumin (g/dL), mean ± SD	4.0 ± 0.6	3.7 ± 0.7	< 0.001
Neutrophil-lymphocyte ratio, mean ± SD	2.65 ± 2.77	3.26 ± 2.75	0.010
American Society of Anesthesiologists			< 0.001
I/II	404 (76.4)	11 (58.7)
III/IV	125 (23.6)	78 (41.3)
Charlson-Deyo comorbidity index			0.014
0	360 (68.1)	110 (58.2)
≥ 1	169 (31.9)	79 (41.8)
Preoperative chemotherapy			0.095
No	237 (44.8)	98 (51.9)
Yes	292 (55.2)	91 (48.1)

Table 2 Surgical and postoperative characteristics of patients according to perioperative red blood cell transfusion

Variable	Non-transfusion	Red blood cell transfusion	P value
	n = 529 (%)	n >= 189 (%)
Type of resection			< 0.001
Subtotal	337 (63.7)	91 (48.1)
Total	192 (36.3)	98 (51.9)
Surgical access			< 0.001
Open	396 (74.9)	168 (88.9)
Minimally invasive	133 (25.1)	21 (11.1)
Type of lymphadenectomy			< 0.001
D1	104 (19.7)	72 (38.1)
D2	425 (80.3)	117 (61.9)
Operation time (min), mean ± SD	243.5 ± 74.3	246.6 ± 77.3	0.636
Intraoperative blood loss (mL), mean ± SD	299.7 ± 336.7	342.0 ± 362.6	0.186
Intraoperative complications			0.209
No	508 (96.0)	178 (94.2)
Yes	21 (4.0)	11 (5.8)
Length of postoperative stay (d), mean ± SD	10.4 ± 7.2	21.6 ± 17.4	< 0.001
Postoperative complications (Clavien-Dindo)			< 0.001
0/I/II (minor)	488 (92.2)	112 (59.3)
III/IV/V (major)	41 (7.8)	77 (40.7)
Adjuvant chemotherapy			0.001
No	287 (54.3)	129 (68.3)
Yes	242 (45.7)	60 (31.7)
Mortality
30-d	8 (1.5)	19 (10.1)	< 0.001
90-d	16 (3.1)	36 (19.0)	< 0.001

Table 3 Pathological characteristics of patients according to perioperative red blood cell transfusion

Variable	Non-transfusion	Red blood cell transfusion	P value
	n >= 529 (%)	n = 189 (%)
Tumor size (cm), mean ± SD	4.3 ± 2.6	6.0 ± 3.6	< 0.001
Tumor location			0.039
Lower	327 (61.8)	95 (50.3)
Middle	130 (24.6)	60 (31.7)
Upper	64 (12.2)	29 (15.3)
Diffuse	8 (1.5)	5 (2.6)
Lauren histologic type1			0.002
Intestinal	276 (52.6)	124 (66.0)
Diffuse/mixed	249 (47.4)	64 (34.0)
Histological differentiation1			0.056
Well/moderate	245 (46.7)	103 (54.8)
Poor	280 (53.3)	85 (45.2)
Lymphatic invasion			0.027
No	293 (55.4)	87 (46.0)
Yes	236 (44.6)	102 (54.0)
Vascular invasion			0.017
No	364 (68.8)	112 (59.3)
Yes	165 (31.2)	77 (40.7)
Perineural invasion			0.001
No	304 (57.5)	83 (43.9)
Yes	225 (42.5)	106 (56.1)
pT status			< 0.001
pT1/T2	248 (46.9)	54 (28.6)
pT3/T4	281 (53.1)	135 (71.4)
Lymph nodes harvested, mean ± SD	41.5 ± 19.4	39.2 ± 19.5	0.175
pN status			0.126
pN0	244 (46.1)	75 (39.7)
pN+	285 (53.9)	114 (60.3)
pTNM stage			< 0.001
I/II	329 (62.2)	86 (45.5)
III/IV	200 (37.8)	103 (54.5)

¹This information was not available in 5 medical records.

pTNM: Pathological tumor node metastasis.

Table 4 Univariate and multivariate analyses of factors associated with risk of receiving perioperative red blood cell transfusion

Variable	Univariate			Multivariate
	OR	95%CI	P value	OR	95%CI	P value
Male vs female	1.19	0.85-1.68	0.319
Age ≥ 65 yr vs < 65 yr	1.48	1.06-2.07	0.02	1.2	0.79-1.81	0.394
Charlson ≥ 1 vs 0	1.53	1.09-2.15	0.015	1.22	0.76-1.97	0.402
ASA III/IV vs I/II	2.27	1.60-3.23	< 0.001	1.18	0,72-1.94	0.507
HB < 11 g/dL vs ≥ 11 g/dL	4.7	3.30-6.70	< 0.001	4.32	2.76-6.78	< 0.001
ALB < 3.5 g/dL vs ≥ 3.5 g/dL	3.49	2.29-5.31	< 0.001	1.86	1.12-3.09	0.017
Total gastrectomy vs distal	1.89	1.35-2.65	< 0.001	1.71	1.13-2.60	0.011
Open surgery vs MIS	2.69	1.64-4.41	< 0.001	1.91	1.05-3.47	0.034
Major POC vs non/minor POC	8.18	5.32-12.59	< 0.001	8.83	5.28-14.79	< 0.001
Intraoperative intercurrence vs none	1.49	0.71-3.16	0.293

ASA: American Society of Anesthesiologists; OR: Odds ratio; HB: Serum hemoglobin; ALB: Serum albumin; MIS: Minimally invasive surgery; POC: Postoperative complications.

Table 5 Univariate and multivariate analyses of factors associated with disease-free and overall survival

	Univariate			Multivariate
	HR	95%CI	P value	HR	95%CI	P value
Disease-free survival
Male vs female	1.27	0.99-1.62	0.051
Age ≥ 65 yr vs < 65 yr	1.25	0.99-1.57	0.059
Charlson ≥ 1 vs 0	1.33	1.05-1.68	0.018	1.22	0.93-1.60	0.159
ASA III/IV vs I/II	1.83	1.44-2.33	< 0.001	1.24	0.93-1.66	0.149
Total gastrectomy vs distal	1.77	1.41-2.33	< 0.001	1.45	1.14-1.84	0.002
D1 vs D2	1.61	1.25-2.07	< 0.001	1.4	1.06-1.85	0.017
pT3/T4 vs pT1/T2	2.87	2.19-3.76	< 0.001	2.05	1.50-2.79	< 0.001
pN+ vs pN0	2.81	2.17-3.65	< 0.001	1.97	1.47-2.65	< 0.001
Major POC vs non/minor POC	2.86	2.19-3.73	< 0.001	2.15	1.62-2.86	< 0.001
Non-CMT vs received CMT	1	0.79-1.26	0.995
Perioperative RBC transfusion vs non	2.39	1.88-3.02	< 0.001	1.49	1.14-1.94	0.003
Overall survival
Male vs female	1.25	0.97-1.61	0.084
Age ≥ 65 yr vs < 65 yr	1.41	1.11-1.80	0.006	1.24	0.95-1.61	0.113
Charlson ≥ 1 vs 0	1.35	1.06-1.73	0.017	1.11	0.83-1.49	0.473
ASA III/IV vs I/II	2.02	1.57-2.61	< 0.001	1.36	1.01-1.85	0.048
Total gastrectomy vs distal	1.65	1.29-2.10	< 0.001	1.33	1.03-1.71	0.027
Lymphadenectomy D1 vs D2	1.81	1.39-2.35	< 0.001	1.51	1.11-2.05	0.008
pT3/T4 vs pT1/T2	2.92	2.19-3.90	< 0.001	2.19	1.57-3.06	< 0.001
pN+ vs pN0	2.7	2.06-3.56	< 0.001	1.87	1.37-2.56	< 0.001
Major POC vs non/minor POC	3.33	2.53-4.38	< 0.001	2.65	1.97-3.56	< 0.001
Non-CMT vs received CMT	1.05	0.83-1.34	0.678
Perioperative RBC transfusion vs non	2.33	1.81-2.99	< 0.001	1.34	1.02-1.77	0.038

ASA: American Society of Anesthesiologists; HR: Hazard ratio; POC: Postoperative complications; CMT: Chemotherapy; RBC: Red blood cell.