Association of perioperative allogeneic blood transfusions and long-term outcomes following radical surgery for gastric and colorectal cancers - systematic review and meta-analysis of propensity-adjusted observational studies

Sep 24, 2026

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Background: Prior meta-analyses linked perioperative allogeneic blood transfusions with poor prognosis in gastric or colorectal cancer, but with substantial confounding risk. This systematic review and meta-analysis evaluates the association using propensity-adjusted observational studies to better account for bias. Methods: PubMed, Embase, and CENTRAL were searched (2013–2022) for studies applying propensity score analysis; pooled hazard ratios for overall survival and disease-free survival used fixed or random effects. Results: Twelve retrospective cohorts (17,607 patients) were included. Propensity-adjusted transfusion showed no association with disease-free survival but was linked to worse overall survival in both gastric and colorectal cancers. Conclusion: Perioperative allogeneic blood transfusion correlates with recurrence risk not increased, yet overall survival worsens, potentially due to residual imbalance in major postoperative complications.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

BJS Open, 2023, zrad075 [https://doi.org/10.1093/bjsopen/zrad075](https://doi.org/10.1093/bjsopen/zrad075) Systematic Review Association of perioperative allogeneic blood transfusions and long-term outcomes following radical surgery for gastric and colorectal cancers: systematic review and meta-analysis of propensity-adjusted observational studies Weilan Zhang1, Huimian Xu2, Baojun Huang2, Yan Xu2 and Jinyu Huang2,* 1Department of Radiology, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, Shenyang, China 2Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, Shenyang, China *Correspondence to: Jinyu Huang, Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, 155 North Nanjing Street, Heping District, Shenyang, 110001, China ([e-mail: huangjinyuzw@126.com](e-mail: huangjinyuzw@126.com)) Abstract Background: Previous meta-analyses reporting significant associations between perioperative allogeneic blood transfusions and poor prognosis in gastric cancer or colorectal cancer had a high risk of confounding bias. This meta-analysis explored this issue using observational studies that applied propensity score analysis. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for manuscripts published between 2013 and 2022. Studies applying propensity score analysis were included to investigate the association between perioperative allogeneic blood transfusions and prognosis in gastric cancer or colorectal cancer after radical surgery. Pooled HRs for overall survival and disease-free survival were calculated using a fixed-effect model or random-effect model according to heterogeneity. Results: Twelve retrospective cohort studies with 17 607 patients reported were included. Ten studies applied propensity score matching and two applied inverse probability of treatment weighting using propensity score. A total of 5962 patients were analysed after propensity score adjustment. After propensity score adjustment, perioperative allogeneic blood transfusions did not correlate with disease-free survival in gastric cancer (HR 1.16; 95 per cent c.i. 0.96–1.39; heterogeneity was assessed by the chi-squared test and inconsistency index (I2) = 57 per cent) or colorectal cancer (HR 1.12; 95 per cent c.i. 0.84–1.49; I2 = 54 per cent) . However, after propensity score adjustment, perioperative allogeneic blood transfusions were significantly associated with worse overall survival in gastric cancer (HR 1.20; 95 per cent c.i. 1.08–1.32; I2 = 25 per cent) and colorectal cancer (HR 1.40; 95 per cent c.i. 1.06–1.85; I2 = 52 per cent) . Subgroup analyses showed that perioperative allogeneic blood transfusions did not correlate with overall survival in colorectal cancer when major postoperative complications were balanced after propensity score. Conclusion: Perioperative allogeneic blood transfusion is not correlated with recurrence of gastric cancer and colorectal cancer. Perioperative allogeneic blood transfusions are significantly associated with worse overall survival in gastric cancer and colorectal cancer, which may be attributable to unbalanced major postoperative complications after propensity score adjustment. Introduction Allogeneic blood transfusion is frequently utilized for patients with gastric cancer (GC) or colorectal cancer (CRC) in the perioperative period because of a high incidence of perioperative anaemia and complex oncologic surgery. Previous meta-analyses of observational studies reported that per

FAQs

Why did the study perform a propensity-adjusted meta-analysis instead of relying on earlier meta-analyses?

Earlier meta-analyses reported associations but had high confounding bias. This review used observational studies that applied propensity score analysis to better control confounding.

What did the analysis find about disease-free survival after propensity score adjustment?

After propensity adjustment, perioperative allogeneic blood transfusions showed no correlation with disease-free survival in gastric cancer or colorectal cancer.

How were overall survival results different from disease-free survival?

After propensity adjustment, perioperative allogeneic blood transfusions were significantly associated with worse overall survival in both gastric cancer and colorectal cancer.

Sep 24, 2026

Uploaded by Angel