Influence of blood transfusion on postoperative inflammation, stress markers, and prognosis in patients with gastric cancer

Table 1 Comparison of demographics characteristics between two groups, mean ± SD/n (%)

Parameters	Non-transfusion group (n = 108)	Transfusion group (n = 92)	t/χ2 value	P value
Age (years)	60.54 ± 10.12	61.14 ± 10.79	0.410	0.682
Sex			0.217	0.641
Male	73 (67.59)	65 (70.65)
Female	35 (32.41)	27 (29.35)
BMI (kg/m2)	24.16 ± 2.73	23.61 ± 2.25	1.545	0.124
ECOG			0.779	0.378
0	93 (86.11)	75 (81.52)
1	15 (13.89)	17 (18.48)
Weight loss			3.607	0.165
0%-5%	71 (65.74)	59 (64.13)
6%-10%	24 (22.22)	14 (15.22)
> 10%	13 (12.04)	19 (20.65)
History of gastric surgery			0.332	0.565
Yes	21 (19.44)	15 (16.30)
No	87 (80.56)	77 (83.70)
Smoking			0.300	0.861
Never	23 (21.30)	17 (18.48)
Former	28 (25.93)	26 (28.26)
Current	57 (52.78)	49 (53.26)
Drinking			0.011	0.995
Never	8 (7.41)	7 (7.61)
Former	11 (10.19)	9 (9.78)
Current	89 (82.41)	76 (82.61)
Employment status			0.009	0.924
Employed	78 (72.22)	67 (72.83)
Unemployed	30 (27.78)	25 (27.17)
Marital status			0.020	0.990
Married	57 (52.78)	49 (53.26)
Single	35 (32.41)	29 (31.52)
Divorced	16 (14.81)	14 (15.22)
Current residence			0.127	0.721
Urban	69 (63.89)	61 (66.30)
Rural	39 (36.11)	31 (33.70)

BMI: Body mass index; ECOG: Eastern Cooperative Oncology Group.

Table 2 Comparison of pathological characteristics between two groups, mean ± SD/n (%)

Parameters	Non-transfusion group (n = 108)	Transfusion group (n = 92)	t/χ2 value	P value
Tumor size (cm)	2.81 ± 1.02	2.89 ± 1.10	0.514	0.608
Node count	27.33 ± 11.43	27.24 ± 10.24	0.060	0.952
Tumor location			6.843	0.077
Upper third	10 (9.26)	3 (3.26)
Middle third	39 (36.11)	24 (26.09)
Lower third	57 (52.78)	64 (69.57)
Entire	2 (1.85)	1 (1.09)
Histology			0.406	0.816
Differentiated	48 (44.44)	41 (44.57)
Undifferentiated	56 (51.85)	49 (53.26)
Others	4 (3.70)	2 (2.17)
T stage			5.726	0.017
≤ T2	65 (60.19)	70 (76.09)
> T2	43 (39.81)	22 (23.91)
N stage			0.436	0.509
N0	56 (51.85)	52 (56.52)
≥ N1	52 (48.15)	40 (43.48)
Gastrectomy			0.061	0.805
Distal subtotal	71 (65.74)	62 (67.39)
Total	7 (34.26)	30 (32.61)
Access			2.787	0.095
Open	53 (49.07)	56 (60.87)
Laparoscopic	55 (50.93)	36 (39.13)
Operation time (minute)	243.55 ± 74.35	246.68 ± 77.33	0.292	0.771
Intraoperative blood loss (mL)	299.72 ± 36.72	322.03 ± 62.65	3.004	0.003

Table 3 Comparison of postoperative complications between two groups, mean ± SD/n (%)

Parameters	Non-transfusion group (n = 108)	Transfusion group (n = 92)	t/χ2 value	P value
Postoperative complications
Bleeding	2 (1.85)	10 (10.87)	7.163	0.007
Anastomotic leak	3 (2.78)	11 (11.96)	6.429	0.011
Duodenal stump leak	2 (1.85)	3 (3.26)	0.033	0.856
Pancreatic fistula	1 (0.93)	2 (2.17)	0.020	0.889
Abdominal collection	5 (4.63)	7 (7.61)	0.782	0.377
Clostridium infection	1 (0.93)	6 (6.52)	3.098	0.078
Wound infection		5 (5.43)	3.997	0.046
Pneumonia	5 (4.63)	6 (6.52)	0.342	0.559
Catheter infection	3 (2.78)	5 (5.43)	0.352	0.553
Urinary infection	1 (0.93)	7 (7.61)	4.169	0.041
Dumping syndrome	2 (1.85)	9 (9.78)	6.012	0.014
Clavien-Dindo complication grade
I	5 (4.63)	8 (8.70)	1.351	0.245
II	11 (10.19)	3 (3.26)	3.659	0.056
IIIa	6 (5.56)	4 (4.35)	0.004	0.948
IIIb		2 (2.17)	0.684	0.408
IVa		2 (2.17)	0.684	0.408
Length of stay (days)	20.01 ± 0.98	19.96 ± 1.02	0.362	0.718

Table 4 Correlation analysis between various variables and prognosis

Variable	r value	P value	Variable	r value	P value
T stage	0.169	0.017	PCT (ng/mL) postoperative day 3	0.187	0.008
Intraoperative blood loss (mL)	0.230	0.001	Cortisol (μmol/L) postoperative day 1	0.181	0.010
WBC (1 × 109/L) postoperative day 1	0.193	0.006	Cortisol (μmol/L) postoperative day 3	0.205	0.004
WBC (1 × 109/L) postoperative day 3	0.173	0.014	Epinephrine (ng/L) postoperative day 1	0.137	0.053
Neutrophil (%) postoperative day 1	0.136	0.055	Epinephrine (ng/L) postoperative day 3	0.211	0.003
Neutrophil (%) postoperative day 3	0.188	0.008	Norepinephrine (ng/L) postoperative day 1	0.231	0.001
NLR postoperative day 1	0.207	0.003	Norepinephrine (ng/L) postoperative day 3	0.243	< 0.001
NLR postoperative day 3	0.219	0.002	Blood glucose(mmol/L) postoperative day 3	0.377	< 0.001
CRP (mg/L) postoperative day 1	0.235	< 0.001	Bleeding	0.189	0.007
CRP (mg/L) postoperative day 3	0.209	0.003	Anastomotic leak	0.179	0.011
IL-6 (pg/mL) postoperative day 1	0.147	0.038	Wound infection	0.173	0.014
IL-6 (pg/mL) postoperative day 3	0.141	0.047	Urinary infection	0.170	0.016
TNF-α (pg/mL) postoperative day 1	0.194	0.006	Dumping syndrome	0.173	0.014
TNF-α (pg/mL) postoperative day 3	0.163	0.021	PCT (ng/mL) postoperative day 1	0.139	0.049

WBC: White blood cell count; NLR: Neutrophil/Lymphocyte ratio; CRP: C-reactive protein; IL-6: Interleukin-6; TNF-α: Tumor necrosis factor-alpha; PCT: Procalcitonin.

Table 5 Multivariate Cox analysis of various indicators on overall survival and disease-free survival

Parameters	Overall survival		Disease-free survival
	HR (95%CI)	P value	HR (95%CI)	P value
Blood transfusion	1.876 (1.293-2.723)	0.004	1.644 (1.134-2.388)	0.014
Age (per 1 year)	1.034 (1.004-1.064)	0.031	1.026 (0.997-1.046)	0.157
Sex (male/female)	0.973 (0.705-1.342)	0.884	0.956 (0.684-1.326)	0.750
BMI (per 1 kg/m²)	0.985 (0.945-1.022)	0.322	1.012 (0.975-1.056)	0.606
ECOG performance status (1/0)	1.516 (1.055-2.175)	0.032	1.425 (0.984-2.056)	0.063
ΔCRP (per 1 mg/L)	1.085 (1.022-1.145)	0.014	1.073 (1.019-1.134)	0.034
ΔIL-6 (per 1 pg/mL)	1.063 (1.016-1.125)	0.034	1.051 (1.007-1.104)	0.052
ΔTNF-α (per 1 pg/mL)	1.106 (1.032-1.172)	0.017	1.091 (1.028-1.165)	0.024
ΔCortisol (per 1 nmol/L)	1.043 (0.993-1.095)	0.128	1.037 (0.984-1.088)	0.216
ΔEpinephrine (per 1 ng/L)	1.032 (0.985-1.083)	0.232	1.027 (0.972-1.076)	0.376
Postoperative complication
Bleeding (yes/no)	1.925 (1.365-2.723)	0.006	1.783 (1.284-2.482)	0.007
Anastomotic leak (yes/no)	2.057 (1.402-3.005)	< 0.001	1.903 (1.305-2.792)	0.004
Duodenal stump leak (yes/no)	1.882 (1.312-2.717)	0.003	1.793 (1.253-2.567)	0.006
Pancreatic fistula (yes/no)	2.108 (1.456-3.044)	< 0.001	1.955 (1.353-2.825)	< 0.001
Abdominal collection (yes/no)	1.752 (1.285-2.398)	0.001	1.623 (1.205-2.196)	0.008
Clostridium infection (yes/no)	1.685 (1.205-2.367)	0.002	1.584 (1.132-2.217)	0.007
Wound infection (yes/no)	1.624 (1.155-2.286)	0.006	1.553 (1.104-2.197)	0.013
Pneumonia (yes/no)	1.802 (1.254-2.587)	0.001	1.703 (1.181-2.454)	0.004
Catheter infection (yes/no)	1.553 (1.083-2.237)	0.018	1.485 (1.027-2.142)	0.037
Urinary infection (yes/no)	1.451 (1.002-2.105)	0.052	1.405 (0.963-2.042)	0.082
Dumping syndrome (yes/no)	1.304 (0.904-1.886)	0.171	1.25 (0.863-1.815)	0.242

HR: Hazard ratio; CI: Confidence interval; BMI: Body mass index; ECOG: Eastern Cooperative Oncology Group; CRP: C-reactive protein; IL-6: Interleukin-6; TNF-α: Tumor necrosis factor-alpha.