Blood transfusion as a risk factor for death in stage III and IV operative laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group.

ABSTRACT

OBJECTIVE: To evaluate the role of a blood transfusion in a patient population with head and neck cancer that was treated with combined therapy (surgery and radiation). DESIGN: Retrospective, nonrandomized end point study. Univariate and multivariate analysis of 24 variables, including transfusion status. SETTING: The Veterans Affairs Cooperative Study (Cooperative Studies Program 268). PATIENTS Patients in the surgical arm of the study (166 patients) underwent surgery and postoperative radiation therapy for advanced (stage III and IV) laryngeal cancer. MAIN OUTCOME MEASURES: Identification of variables related to patient time to death. RESULTS: The univariate analysis identified age, clinical N (lymph node) class, primary tumor site, number of pathologically positive lymph nodes, extracapsular spread, pretreatment screening hematocrit, hematocrit and albumin level at 1 month after treatment, intraoperative fluids and units of blood, and total units of blood as significant (P < .05). The stepwise multivariate models identified independent significance in clinical and pathologic node status, hematocrits at both screening and 1 month, extracapsular spread, albumin level at 1 month, age, and primary site. The position of each variable within the individual regression models varied. CONCLUSIONS: Clinical N class or pathologic node status occupied the first position of predictive significance in all models. Blood transfusion status never retained independent significance in any multivariate assessment.