The relationship between perioperative blood transfusion and overall mortality in patients undergoing radical cystectomy for bladder cancer

Abstract

Objectives The relationship between perioperative blood transfusion (PBT) and oncologic outcomes is controversial. In patients undergoing surgery for colon cancer and several other solid malignancies, PBT has been associated with an increased risk of mortality. Yet, the urologic literature has a paucity of data addressing this topic. We sought to evaluate whether PBT affects overall survival following radical cystectomy (RC) for patients with bladder cancer. Methods The medical records of 777 consecutive patients undergoing RC for urothelial carcinoma of the bladder were reviewed. PBT was defined as transfusion of red blood cells during RC or within the postoperative hospitalization. The primary outcome was overall survival. Clinical and pathologic variables were compared using chi-squared tests, and Cox multivariate survival analyses were performed. Results A total of 323 patients (41.6%) underwent PBT. In the univariate analysis, PBT was associated with increased overall mortality (HR 1.40, 95%CI 1.11–1.78). Additionally, an independent association was demonstrated in a nontransformed logistic regression model(HR, 95%CI 1.01–1.36) but not in a model utilizing restricted cubic splines(HR 1.03, 95%CI 0.77–1.38). The c-index was 0.78 for the first model and 0.79 for the second. Conclusions In a traditional multivariate model, mirroring those that have been applied to this question in the general surgery literature, we demonstrated an association between PBT and overall mortality after RC. However, this relationship is not observed in a second statistical model. Given the complex nature of adequately controlling for confounding factors in studies of PBT, prospective study will be necessary to fully elucidate the independent risks associated with PBT.

Treatment of Cancer-Associated Anaemia: Results from a Two-Day Cross-Sectional Survey in Germany

“…By contrast, several recent prospective randomised trials using ESA with curative intent did not provide evidence of an impact on survival or relapse in patients with Hodgkin's lymphoma [46], aggressive lymphoma [47], cervical cancer [48] and early breast cancer [49]. Furthermore, several studies and 3 meta-analyses [20,21,50] have shown that transfusions rather increase the risk of complications such as cardiovascular disease [23], acute lung injury [19], haemolytic reactions [19], postoperative infection [19,20] and surgical re-intervention [20], as well as the risk of relapse [20,21,24], all-cause [19,20,22,23,24,51] and cancer-related mortality [20], and may induce malignant lymphomas [50]. …”

“…The former are not sustainable, inconvenient for the patient and entail increased risks of blood-borne infectious diseases and adverse immune reactions. Furthermore, they may increase the risk of relapse and decreased survival [16,17,18,19,20,21,22,23,24]. These disadvantages fostered the use of ESA, although these were expensive and not all patients responded to treatment [25].…”

Perioperative Blood Transfusion and Radical Cystectomy: Does Timing of Transfusion Affect Bladder Cancer Mortality?

“…Introduction Perioperative blood transfusion (BT) has been associated with adverse cancer-specific mortality in many malignancies [1][2][3][4], including bladder cancer [5][6][7]. An immunosuppressive effect from BT has been well described in many studies [8].…”

“…Perioperative BT is administered to approximately 60% of patients undergoing this surgery [6] and three recent studies have demonstrated an association of perioperative BT with bladder cancer-specific survival in patients undergoing RC [5][6][7]. However, there is a paucity of data that specifically examine the importance of the timing of BT and it is unknown whether outcomes differ for patients who receive blood during surgery compared with those who receive blood after surgery, during their postoperative hospitalization.…”

Perioperative management and oncological outcomes following radical cystectomy for bladder cancer: a matched retrospective cohort study

“…Nevertheless, the results of two recent studies showed that perioperative blood transfusions were associated with worse oncological outcomes in patients with bladder cancer, albeit only in univariable analyses. 49,50 Further, findings in another large study (n = 2,060) from MCRCR showed that the increased number of blood units transfused was associated with reduced cancerspecific survival and all-cause mortality. 51 The timespan of that study 51 partially overlaps with the present report (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007); however, we reconfirmed a strong association between blood transfusion and adverse oncological outcomes on a substantially smaller patient cohort.…”