Red Blood Cell Transfusions Impact Survival Outcomes in Endometrial Cancer


Receipt of red blood cell transfusions can negatively impact survival outcomes in patients with endometrial cancers, while ovarian cancers were most affected by preoperative global health status.

Receipt of red blood cell (RBC) transfusions had a negative effect on prognosis for patients with endometrial cancer, and preoperative global health status had the most significant impact in the ovarian cancer space, according to a study published in Frontiers of Oncology.

A significantly shorter 5-year progression-free survival (PFS) was observed in patients with endometrial cancer who received a RBC transfusion (26.0%) vs those who didn’t (79.8%; P <.001). Five-year overall survival (OS) was also lower in the transfusion arm (25.7%) compared with the non-transfusion arm (82.6%; P <.001). In the multivariable analysis, the only significant prognostic parameter was RBC transfusion for progression-free survival (PFS; HR, 1.76; 95% CI, 1.01-3.07) and OS (HR, 2.38; 95% CI, 1.50-3.78).

Among those with ovarian cancer, a lower PFS was observed in G8-frail patients (16.7%) compared with non-frail patients (53.4%; P = .0101). The estimated 5-year OS rate was 40.5% for patients who were G8 non-frail and 15.3% for those who were G8-frail (P = .149). Moreover, 5-year OS for anemic patients was 10.6% vs 36.7% for non-anemic patients. Both G8 score (HR, 2.23; 95% CI, 1.16-4.32) and FIGO stage (HR, 6.52; 95% CI, 1.51-28.07) were independent prognostic factors for PFS.

Factors That Impact Prognosis in Endometrial Cancer

A total of 152 patients were included in the endometrial cancer cohort. The median follow-up was 31.0 months. Patients with a higher FIGO stage were significantly more likely to receive a RBC transfusion vs lower stages. Moreover, patients with endometrioid cancers did a higher rate of transfusion than those with non–endometrioid cancers (63.2% vs 36.8%; P = .005)

RBC transfusions were administered to 84.2% of patients, 63.2% which were given during surgical procedures. Additionally, preoperative anemia of cancer was associated with RBC transfusion indication in this cohort (P <.001). Patients had a mean cut-seam time of 142.4 minutes and a mean intraoperative blood loss of 229.6 mL. A total of 32.0% of patients underwent laparoscopic surgery, 49.7% had open surgery, and 18.3% had vaginal surgery.

Operative revisions were deemed necessary in 4 patients, 2 of whom had an incarcerated intestinal loop and had postoperative hemorrhage. In 94.7% of patients, surgery was performed without any residual tumor burden. Frailty was not found to impact surgical radicality. Additional treatment included adjuvant chemotherapy in 9.2% of patients and adjuvant radiotherapy in 43.9%.

In total, 38.9% of patients were classified as G8 frail and 61.1% were G8 non-frail. Patients who were frail received more RBC transfusions than those who were not (83.3% vs 16.7%; P <.001). Moreover, those who were frail had lower survival rates than their counterparts. Intraoperative RBC transfusion had a more notable impact on survival than preoperative frailty status (25.7% vs 49.7%)

The 5-year overall survival rate for patients who were not anemic was 81.2% compared with 57.1% for those who were (P <.001). The rates were 88.2% and 49.7%, respectively, for patients who were G8 non-frail and those who were G8 frail (P <.001).

How Global Health Status Affects Outcomes in Ovarian Cancer

A total of 111 patients with ovarian cancer were enrolled, of whom 51.4% underwent RBC transfusion. Anemia of cancer was observed in 34.7% of patients, of whom 47.3% received RBC transfusions. However, 26.9% did not receive a transfusion along with 73.1% of patients who were not anemic (P = .030). Patients had a mean operation time of 260.0 minutes and a mean blood loss of 1015.32 mL. Primary debulking surgery was performed in 78.1% of patients, and 21.9% had interval debulking.

Operative revisions were needed in 19 patients because of deep and superficial dehiscence in 8, intestinal complications and anastomosis insufficiencies or peritonitis in 7, and surgical bleeding in 4. Of these patients, RBC transfusions were necessary in 73.7% of patients after surgery. No residual tumor burden was observed in 58.3% of patients. Additionally, surgical radicality was associated with RBC transfusions, as determined by surgical complexity score (P = .062), and postoperative residual tumor burden (P = .017).

In total 48.1% of patients were classified as G8 frail and 51.9% were G8 non-frail. Overall, 58.2% of patients who were frail vs 41.8% underwent transfusion (P = .031). There was no significant difference in prognosis for patients with ovarian cancer who received RBC transfusions (P = .073).


Anic K, Schmidt MW, Schmidt M, et al. Impact of perioperative red blood cell transfusion, anemia of cancer and global health status on the prognosis of elderly patients with endometrial and ovarian cancer. Front Oncol. 2022;12:967421. doi:10.3389/fonc.2022.967421

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