Negative Impact of Intra-Operative Blood Transfusion on Survival Outcomes of Hepatocellular Carcinoma Patients

Figures & data

Table 1 Baseline Characteristics of Patients Who Received a Blood Transfusion and Those Who Did Not in Different HCC Size Subsets in the Entire Cohort (n=484)

Variables	Size >4 cm (n=236)			Size ≤4 cm (n=248)
	Non-Blood Transfusion (n=185)	Blood Transfusion (n=51)	P-value	Non-Blood Transfusion (n=197)	Blood Transfusion (n=51)	P-value
Gender			0.994			0.614
Male	145(78.4)	40(78.4)		157(79.7)	39(76.5)
Female	40(21.6)	11(21.6)		40(20.3)	12(23.5)
Age (yr)	53±9.3	55±8.8	0.647	54±8.8	55±8.6	0.841
BMI (㎏/㎡)	24.3±3.2	25.1±2.9	0.256	24.7±3.2	24.5±3.3	0.312
ASA			0.354			1.000
1	1(0.5)	0		5(2.5)	1(2.0)
2	180(97.3)	48(94.1)		189(95.9)	49(96.1)
3	4(2.2)	3(5.9)		3(1.5)	1(2.0)
TNM			0.585			0.830
I	111(60.0)	27(52.9)		131(66.5)	32(62.7)
II	19(10.3)	5(9.8)		55(27.9)	16(31.4)
III	55(29.7)	19(37.3)		11(5.6)	3(5.9)
Tumor thrombus			0.187			0.086
Yes	32(17.3)	13(25.5)		27(13.7)	12(23.5)
No	153(82.7)	38(74.5)		170(86.3)	39(76.5)
High blood pressure			0.021			0.321
Yes	36(19.5)	3(5.9)		30(15.2)	5(9.8)
No	149(80.5)	48(94.1)		167(84.8)	46(90.2)
Diabetes			1.000			0.903
Yes	15(8.1)	4(7.8)		15(7.6)	3(5.9)
No	170(91.9)	47(92.2)		182(92.4)	48(94.1)
Fentanyl equivalents			0.001			<0.001
≤1.500mg	100(54.1)	14(27.5)		114(57.9)	15(29.4)
>1.500mg	85(45.9)	37(72.5)		83(42.1)	36(70.6)
Duration of operation			<0.001			<0.001
≤2.170h	98(53.0)	6(11.8)		132(67.0)	12(23.5)
>2.170h	87(47.0)	45(88.2)		65(33.0)	39(76.5)

Table 2 Baseline Characteristics of Patients Who Received a Blood Transfusion and Those Who Did Not in Different HCC Size Subsets in the Matched Cohort (n=174)

Variables	Size >4 cm (n=88)			Size ≤4 cm (n=86)
	Non-Blood Transfusion (n=44)	Blood Transfusion (n=44)	P-value	Non-Blood Transfusion (n=43)	Blood Transfusion (n=43)	P-value
Gender			1.000			1.000
Male	34(77.3)	34(77.3)		33(76.7)	33(76.7)
Female	10(22.7)	10(22.7)		10(23.3)	10(23.3)
Age (yr)	56±7.8	55±8.7	0.551	56±7.8	55±8.7	0.551
BMI (㎏/㎡)	24.7±3.5	24.5±2.6	0.806	24.7±3.5	24.5±2.6	0.806
ASA			0.609			1.000
1	0	0		2(4.7)	1(2.3)
2	41(93.2)	43(97.7)		40(93.0)	41(95.3)
3	3(6.8)	1(2.3)		1(2.3)	1(2.3)
TNM			0.119			0.255
I	24(54.5)	26(59.1)		32(74.4)	28(65.1)
II	8(18.2)	2(4.5)		8(18.6)	14(32.6)
III	12(27.3)	16(36.4)		3(7.0)	1(2.3)
Tumor thrombus			0.437			0.559
Yes	11(25.0)	8(18.2)		6(14.0)	8(18.6)
No	33(75.0)	36(81.8)		37(86.0)	35(81.4)
High blood pressure			1.000			0.710
Yes	4(9.1)	3(6.8)		3(7.0)	5(11.6)
No	40(90.9)	41(93.2)		40(93.0)	38(88.4)
Diabetes			1.000			0.710
Yes	3(6.8)	3(6.8)		5(11.6)	3(7.0)
No	41(93.2)	41(93.2)		38(88.4)	40(93.0)
Fentanyl equivalents			0.189			0.051
≤1.500mg	20(45.5)	14(31.8)		24(55.8)	15(34.9)
>1.500mg	24(54.5)	30(68.2)		19(44.2)	28(65.1)
Duration of operation			0.764			0.808
≤2.170h	7(15.9)	6(13.6)		11(25.6)	12(27.9)
>2.170h	37(84.1)	38(86.4)		32(74.4)	31(72.1)

Table 3 Univariable and Multivariable Cox Regression Analysis of Recurrence-Free Survival after Resection for HCC in Propensity-Matched Patients with a Tumor Size of >4 Cm

Variables	Univariable Analysis		Multivariable Analysis
	HR (95% CI)	P-value	HR (95% CI)	P-value
Gender (ref: Male)	0.518(0.253–1.058)	0.063
Age (yr)	0.954(0.924–0.986)	0.005	0.966(0.934–0.998)	0.040
BMI (㎏/㎡)	0.985(0.904–1.073)	0.731
ASA (ref:2)	0.703(0.171–2.887)	0.619
TNM (ref:I)
II	0.871(0.336–2.256)	0.776	0.900(0.338–2.400)	0.834
III	1.954(1.115–3.425)	0.019	1.923(1.097–3.371)	0.022
Tumor thrombus (ref: Yes)	0.881(0.464–1.673)	0.695
High blood pressure (ref: No)	0.648(0.202–2.075)	0.457
Diabetes (ref: Yes)	0.711(0.256–1.973)	0.506
Fentanyl equivalents, >1.500mg (ref: ≤1.500mg)	1.176(0.679–2.038)	0.559
Duration of operation, >2.170h (ref: ≤2.170h)	0.901(0.440–1.841)	0.772
Blood transfusion (ref: No)	2.186(1.261–3.791)	0.004	2.011(1.146–3.529)	0.015

Table 4 Univariable and Multivariable Cox Regression Analysis of Overall Survival After Resection for HCC in Propensity-Matched Patients with a Tumor Size of >4 Cm

Variables	Univariable Analysis		Multivariable Analysis
	HR (95% CI)	P-value	HR (95% CI)	P-value
Gender (ref: Male)	0.497(0.193–1.278)	0.136
Age (yr)	0.982(0.944–1.022)	0.376
BMI (㎏/㎡)	0.995(0.893–1.108)	0.928
ASA (ref:2)	1.217(0.292–5.075)	0.786
TNM (ref:I)
II	0.484(0.112–2.096)	0.332	0.590(0.134–2.599)	0.485
III	2.276(1.157–4.474)	0.017	2.222(1.130–4.368)	0.021
Tumor thrombus (ref: Yes)	0.575(0.276–1.198)	0.132
High blood pressure (ref: No)	0.587(0.141–2.443)	0.456
Diabetes (ref: Yes)	1.142(0.274–4.754)	0.855
Fentanyl equivalents, >1.500mg (ref: ≤1.500mg)	0.975(0.499–1.905)	0.940
Duration of operation, >2.170h (ref: ≤2.170h)	0.670(0.293–1.532)	0.336
Blood transfusion (ref: No)	2.100(1.063–4.147)	0.028	1.862(0.933–3.715)	0.078

Table 5 Univariable Cox Regression Analysis of Recurrence-Free Survival and Overall Survival Identified after Resection for HCC in Propensity-Matched Patients with a Tumor Size of ≤4 Cm

Variables	RFS		OS
	HR (95% CI)	P-value	HR (95% CI)	P-value
Gender (ref: Male)	0.662(0.308–1.424)	0.284	0.753(0.286–1.983)	0.563
Age (yr)	0.982(0.950–1.015)	0.277	0.994(0.954–1.035)	0.763
BMI (㎏/㎡)	0.998(0.905–1.102)	0.975	0.953(0.839–1.182)	0.456
ASA (2, 3 ref:1)	0.538(0.129–2.237)	0.394	0.959(0.129–7.121)	0.967
TNM (ref:I)
II	0.894(0.440–1.817)	0.757	0.831(0.332–2.084)	0.694
III	1.200(0.286–5.034)	0.804	2.345(0.536–10.249)	0.257
Tumor thrombus (ref: Yes)	2.954(0.914–9.552)	0.055	2.328(0.551–9.837)	0.235
High blood pressure (ref: No)	1.052(0.373–2.964)	0.923	0.501(0.067–3.733)	0.490
Diabetes (ref: Yes)	0.473(0.210–1.063)	0.061	0.952(0.287–3.158)	0.935
Fentanyl equivalents, >1.500mg (ref: ≤1.500mg)	0.957(0.530–1.728)	0.883	1.263(0.594–2.683)	0.542
Duration of operation, >2.170h (ref: ≤2.170h)	1.337(0.687–2.599)	0.387	2.016(0.803–5.062)	0.128
Transfused any blood product (ref: No)	1.266(0.702–2.282)	0.427	1.533(0.726–3.322)	0.251

Figure 1 Kaplan–Meier curves for recurrence-free survival of blood transfusion and non-blood transfusion groups after PSM: >4 cm subset group.

Figure 2 Kaplan–Meier curves for overall survival of blood transfusion and non-blood transfusion groups after PSM: >4 cm subset group.

Figure 3 Kaplan–Meier curves for recurrence-free survival of blood transfusion and non-blood transfusion groups after PSM: ≤4 cm subset group.

Figure 4 Kaplan–Meier curves for overall survival of blood transfusion and non-blood transfusion groups after PSM: ≤4 cm subset group.