OBJECTIVES: To determine the association between perioperative blood transfusions (PBT) and oncologic outcomes in a large multi-institutional cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB).
PATIENTS AND METHODS: Retrospective analysis of 2,895 patients treated with RC for UCB. Univariable and multivariable Cox regression models analyzed the effect of PBT administration on disease recurrence, cancer-specific mortality, and any-cause mortality.
RESULTS: Overall, the median age was 67 years (interquartile range (IQR): 60, 73); the median follow-up was 36.1 months (IQR: 15, 84). Patients who received a PBT were more likely to have advanced disease (p< 0.001), high-grade tumors (p=0.047), and nodal metastasis (p=0.004). PBT was associated with an increased risk of disease recurrence (p=0.003), cancer-specific mortality (p=0.017), and any-cause mortality (p=0.010) in univariable, but not multivariable analyses (p>0.05). In multivariable analyses, pathologic tumor stage, pathologic nodal staging, soft tissue surgical margin, lymphovascular invasion, and administration of adjuvant chemotherapy were independent predictors of disease recurrence, cancer-specific mortality and any-cause mortality (all p values < 0.002).
CONCLUSIONS: Patients with UCB who underwent RC and received PBT are at greater risk for disease recurrence, cancer-specific mortality, and any-cause mortality in univariable, but not multivariable analysis. While the etiology of increased PBT with more advanced disease is likely multifactorial including surgical and cancer related factors, the disease characteristics rather than need for PBT are the cause of worse outcomes in this analysis.
Written by:
Kluth LA, Xylinas E, Rieken M, Ghouayel ME, Sun M, Karakiewicz PI, Lotan Y, Chun FK, Boorjian SA, Lee RK, Briganti A, Rouprêt M, Fisch M, Scherr DS, Shariat SF. Are you the author?
Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
Reference: BJU Int. 2013 Sep 5. Epub ahead of print.
doi: 10.1111/bju.12439
PubMed Abstract
PMID: 24053618
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