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Transfusion use and effect on progression-free, overall survival, and quality of life in upfront treatment of advanced epithelial ovarian cancer: evaluation of the European Organization for Research and Treatment EORTC-55971 Cohort
  1. Lauren Shore Prescott1,
  2. Ignace Vergote2,
  3. Charlotte C Sun3,
  4. Diane C Bodurka3 and
  5. Robert L Coleman4
  1. 1Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  2. 2Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
  3. 3Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  4. 4The US Oncology Network, The Woodlands, Texas, USA
  1. Correspondence to Dr Lauren Shore Prescott, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37212, USA; lauren.prescott{at}vumc.org

Abstract

Background The impact of blood transfusion on ovarian cancer survival is uncertain.

Objective To investigate whether peri-operative blood transfusion negatively impacted progression-free survival, overall survival, and quality of life in patients with advanced ovarian cancer.

Methods We performed an ancillary analysis of the European Organization for Research and Treatment (EORTC) 55971 phase III trial, in which patients were randomized to primary debulking surgery versus neoadjuvant chemotherapy. Patients included in the per-protocol analysis were categorized by receipt of a transfusion.

Results 612 of 632 (97%) of patients had adequate data for analysis. Of those, 323 (53%) received a transfusion. The transfusion cohort was more likely to have had better Word Health Organization (WHO) performance status, serous histology, undergone primary debulking surgery, and received more aggressive surgery, with higher rates of no gross residual disease. Median overall survival was 34.0 vs 35.2 months in the no transfusion and transfusion cohorts (p=0.97). The adjusted HR for death was 1.18 (95% CI 0.94 to 1.48) in favor of the transfusion cohort. Median progression-free survival was 13.6 vs 12.6 months in the no transfusion and transfusion cohorts (p=0.96). The adjusted HR for progression was 1.14 (95% CI 0.91 to 1.43). There were no significant differences in global quality of life, fatigue, dyspnea, or physical functioning between the two cohorts at baseline or at any of the four assessment times. Grade 3 and 4 surgical site infections were more common in the transfusion cohort.

Conclusion Transfusion did not negatively impact progression-free survival or overall survival; however, it was associated with increased peri-operative morbidity without improvements in quality of life.

  • Ovarian Neoplasms
  • Surgery

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @LPrescottMD, @rcoledude

  • Contributors LSP: (1) Involved in conception and design of the project, analysis, and interpretation of data; (2) participated in drafting the article and revising it critically for important intellectual content; (3) approved the final manuscript. IV: (1) Involved in conception and design of the project, acquisition of data, analysis, and interpretation of data;(2) participated in drafting the article and revising it critically for important intellectual content; (3) approved the final manuscript. CCS: (1) Involved in conception and design of the project, analysis, and interpretation of data; (2) participated in drafting the article and revising it critically for important intellectual content; (3) approved the final manuscript. DCB: (1) Involved in conception and design of the project; (2) participated in drafting the article and revising it critically for important intellectual content; (3) approved the final manuscript. RLC: (1) Involved in conception and design of the project, analysis and interpretation of data; (2) participated in drafting the article and revising it critically for important intellectual content; (3) approved the final manuscript.

  • Funding This research was supported in part by the National Institutes of Health through MD Anderson Cancer Center’s support grant CA016672, the Ann Rife Cox Chair in Gynecology, and the Judy Reis/Al Pisani, MD Ovarian Cancer Research Fund. LSP was supported for work on this projectb y a NIH T32 grant, Training of Academic Gynecologic Oncologists, from the National Cancer Institute (5T32-CA101642).

  • Competing interests RLC: grants from AstraZeneca, Clovis, Genelux, Genmab, Merck, Immunogen Janssen, Roche/Genentech; consulting fees from Agenus, Alkermes, AstraZeneca, Clovis, Deciphera, Genelux, Genmab, GSK, Immunogen Janssen, OncoQuest, Onxeo, Onxerna, Regeneron, Roche/Genentech; participated in a data safety monitoring board or advisory board - VBL therapeutics. LSP: advisory board tempus, payment or honoraria for lectures from Clinical Care Options. CCS: research funding AstraZeneca; payment or honoraria from Ludemann Family Fund. IV: grants or contracts Amgen, Roche, Oncoinvent; consulting fees - Amgen (Europe) GmbH (2019), AstraZeneca (2019-2020), Clovis Oncology inc. (2019), Carrick Therapeutics (2019), Deciphera Pharmaceuticals (2020), Elevar Therapeutics (2020), F. Hoffmann-La Roche Ltd (2019-2020), Genmab (2019-2020), GSK (2019-2020), Immunogen Inc. (20192020), Mersana (2020), Millennium Pharmaceuticals (2019), MSD (2019-2020), Novocure (2020), Octimet Oncology (2019), Oncoinvent AS (2019-2020), Sotio a.s. (2019-2020), Verastem Oncology (2020), Zentalis (2020) Deciphera Pharmaceuticals (2021), Jazzpharma (2021-2022), Oncoinvent AS (2021-2022); payment or honoraria - Agenus (2021), Aksebio (2021), AstraZeneca (2021-2022), Bristol Myers Squibb (2021), Deciphera Pharmaceuticals (2021), Eisai (2021), F. Hoffmann-La Roche Ltd (2021), Genmab (2021), GSK (2021), Immunogen Inc. (2021-2022), Jazzpharma (2021-2022), Karyopharm (2021), MSD (2021-2022), Novocure (2021-2022), Novartis (2021), Oncoinvent AS (2021-2022), Seagen (2021), Sotio a.s. (2021-2022); meeting support - Amgen, MSD, Tesaro, AstraZeneca, Roche advisory board - Agenus (2021), AstraZeneca (2021-2022), Bristol Myers Squibb (2021), Deciphera Pharmaceuticals (2021), Eisai (2021), F. Hoffmann-La Roche Ltd (2021), Genmab (2021), GSK (2021), Immunogen Inc. (2021-2022), MSD (2021-2022), Novocure (2021-2022), Novartis (2021), Seagen (2021), Sotio a.s. (2021-2022)

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