Combined Effect of Transfusion and Blood Groups on the Survival of Patients With Breast Cancer. A Clinical Study of 901 Patients †

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Abstract
Previous reports by the authors and by others have shown that trans fusion adversely affects the survival of cancer patients. To delineate fur ther the mechanism of action of blood transfusion on biological behavior of cancer, the authors studied the role of the major blood groups ABO in 901 patients who had all undergone radi cal surgery for operable primary breast cancer and among whom 294 had received at least one unit of whole blood perioperatively. Multivariate analysis using Cox's regression models on life tables was used. It was found that the adverse effect of transfusion on survival was a blood group-related phenomenon manifesting its action in patients with blood groups A and B (P = 0.0006 and P = 0.006 respectively). The most im pressive effect of transfusion was seen in patients whose age was be tween forty-one and fifty (51.9% ten- year actuarial survival in 47 transfused patients compared with 73.9% in 70 nontransfused ones). A hypothesis is presented suggest ing that transfusion exerts its effect on the hemostatic system, promoting clotting in group A and B patients and fibrinolysis in group O and AB patients, and thus affects metastatic cascade, with results that have been presented in this series.