Preoperative red blood cell transfusion improves treatment response and survival in patients with locally advanced esophageal cancer and iron deficiency anemia.

Background: Locally advanced esophageal cancer presents significant treatment challenges, with iron deficiency anemia (IDA) potentially hindering the efficacy of neoadjuvant chemotherapy. This study aimed to evaluate the effect of preoperative red blood cell transfusion on tumor progression and chemotherapy response in patients with IDA.

Methods: A retrospective cohort study was conducted at Shaanxi Provincial Cancer Hospital, involving 228 patients with locally advanced esophageal cancer and IDA, from August 2015 to August 2021. Patients were divided into two groups: 106 patients received preoperative red blood cell transfusions, and 122 did not. All patients underwent a standardized chemotherapy regimen followed by surgery. Hematological, immunological, and biochemical parameters, as well as chemotherapy-related adverse events, and survival outcomes were analyzed.

Results: Preoperative transfusion significantly increased hemoglobin (Hb) levels (P < 0.05), enhanced immunological profiles (e.g., NK/T cell activity; P < 0.05), and reduced systemic inflammation (e.g., CRP; P < 0.05) after chemotherapy and operation. Overall survival and progression-free survival were notably better in the transfusion group (P = 0.002 and P = 0.012, respectively).

Conclusion: Preoperative red blood cell transfusion improves hematological and immunological parameters and enhances survival outcomes in patients with locally advanced esophageal cancer and IDA.