J Cancer 2019; 10(15):3526-3532. doi:10.7150/jca.28953

Research Paper

Preoperative Immune Response is Associated with Perioperative Transfusion Requirements in Glioma Surgery

Qi Zhang1, Huahui Wu2, Jingjun Zhang1, Qi Qi1, Wei Zhang3✉, Rong Xia1✉

1. Department of Blood Transfusion, Huashan Hospital, Fudan University, Shanghai, China
2. Harbin Hospital of Traditional Chinese Medicine, Harbin, Heilongjiang, China
3. Department of Medical Imaging, Renji Hospital, Medical School of Jiaotong University, Shanghai, China

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Zhang Q, Wu H, Zhang J, Qi Q, Zhang W, Xia R. Preoperative Immune Response is Associated with Perioperative Transfusion Requirements in Glioma Surgery. J Cancer 2019; 10(15):3526-3532. doi:10.7150/jca.28953. Available from http://www.jcancer.org/v10p3526.htm

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Immunosuppression induced by transfusion causes postoperative adverse events including poor prognosis in cancer, but data on influence of the immune response on blood transfusion requirements during perioperative period are limited. The aim of this study was to investigate whether the preoperative immune response is associated with perioperative blood cell transfusion in a glioma surgical patient population. The authors identified 321 cases of surgery for treatment of glioma. Patient variables, preoperative laboratory variables (hemoglobin, platelet count, activated partial thromboplastin time, prothrombin time, hematocrit, red and white blood cell count), and transfusions were registered. Plasma concentration of Th-associated cytokines was measured by flow cytometry. Multivariable regression analysis and receiver operating characteristic curve were undertaken to identify predictors of transfusion. Of 321 patients, 157 (48.90%) received red blood cells transfusion. The mean age is significantly higher in transfusion group compared to no transfusion group, while postoperative hospital stay, preoperative hemoglobin, prothrombin time, activated partial thromboplastin time, platelet count, red and white blood cell count and hematocrit of patients did not differ significantly between the two groups. No significant differences of IL-2, -4, -6, -10 and INF-γ concentration were observed between transfusion and no transfusion group. The concentration of TNF and IL-17A was significantly lower in transfusion patients than in the no transfusion subjects. Low plasma TNF and IL-17A levels predicted high perioperative transfusion rate, the combination of them enlarged the prognostic accuracy of testing. Our study demonstrates that the preoperative immune response influences transfusion requirements, and TNF and IL-17 are important predictive risk factors for perioperative use of blood components in glioma patients.

Keywords: immune response, transfusion requirements, cytokines, glioma surgery, preoperation