Anaemia, blood transfusions and survival in high-grade endometrial cancer: retrospective study.

Objective: To determine if anaemia and blood transfusions in the perioperative, chemotherapy and radiation treatment periods are associated with overall survival (OS) and recurrence-free survival (RFS) in high-grade endometrial cancer.

Methods: This retrospective cohort study examined patients at a single centre treated for high-grade endometrial cancer (2010-2023). This included International Federation of Gynecology and Obstetrics (FIGO) grade 3 endometrioid, serous, carcinosarcoma, mixed, clear cell, mucinous, dedifferentiated and undifferentiated histology. Primary outcomes were OS and RFS. Predictor variables were nadir haemoglobin and transfusion status. Multivariable Cox regression models for OS and RFS analysed the associations of treatment period-specific anaemia, overall transfusion status and confounder variables.

Results: Two hundred twenty-seven cases were included; 64-86% of patients were anaemic during any treatment, with 0-10% having severe anaemia. Twenty-two patients (9.7%) had at least one blood transfusion. Transfusion in the perioperative and chemotherapy periods was associated with poorer survival, significant only for shorter RFS in the chemotherapy cohort (HR 3.22, p=0.04). There was no association between anaemia and survival.

Conclusion: This study is among the first to assess anaemia in treated patients with high-grade endometrial cancer and the associations of anaemia and blood transfusion with survival outcomes. Further larger studies are needed to strengthen evidence and guide transfusion policies.