Korean J Urol.  2015 Apr;56(4):295-304. 10.4111/kju.2015.56.4.295.

The prognostic impact of perioperative blood transfusion on survival in patients with bladder urothelial carcinoma treated with radical cystectomy

• Lee JS
• Kim HS
• Jeong CW
• Kwak C
• Kim HH
• Ku JH

• KMID: 2155305
• DOI: http://doi.org/10.4111/kju.2015.56.4.295

Abstract

PURPOSE
The aim of our study was to assess the influence of perioperative blood transfusion (PBT) on survival outcomes following radical cystectomy (RC) and pelvic lymph node dissection (PLND).
MATERIALS AND METHODS
We reviewed and analyzed the clinical data of 432 patients who underwent RC for bladder cancer from 1991 to 2012. PBT was defined as the transfusion of allogeneic red blood cells during RC or postoperative hospitalization.
RESULTS
Of all patients, 315 patients (72.9%) received PBT. On multivariate logistic regression analysis, female gender (p=0.015), a lower preoperative hemoglobin level (p=0.003), estimated blood loss>800 mL (p<0.001), and performance of neoadjuvant chemotherapy (p<0.001) were independent risk factors related to requiring perioperative transfusions. The receipt of PBT was associated with increased overall mortality (hazard ratio, 1.91; 95% confidence interval, 1.25-2.94; p=0.003) on univariate analysis, but its association was not confirmed by multivariate analysis (p=0.058). In transfused patients, a transfusion of >4 packed red blood cell units was an independent predictor of overall survival (p=0.007), but not in cancer specific survival.
CONCLUSIONS
Our study was not conclusive to detect a clear association between PBT and survival after RC. However, the efforts should be made to continue limiting the overuse of transfusion especially in patients who are expected to have a high probability of PBT, such as females and those with a low preoperative hemoglobin level and history of neoadjuvant chemotherapy.

Keyword

Blood transfusion; Cystectomy; Survival; Urinary bladder neoplasms

MeSH Terms

Aged
*Blood Transfusion/methods/mortality
*Carcinoma, Transitional Cell/mortality/pathology/surgery
Disease-Free Survival
Female
Humans
Kaplan-Meier Estimate
Lymph Node Excision/*methods
Male
Middle Aged
Pelvis/pathology/surgery
Perioperative Care/methods
Prognosis
Republic of Korea/epidemiology
Retrospective Studies
Risk Factors
Treatment Outcome
Urinary Bladder/pathology
*Urinary Bladder Neoplasms/mortality/pathology/surgery

Figure

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  Fig. 1 Kaplan-Meier curves for overall survival (A) and cancer-specific survival (B) in the entire study cohort according to the administration of perioperative blood transfusion (PBT).

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  Fig. 2 Kaplan-Meier curves for overall survival in patients receiving perioperative blood transfusion according to transfused units of packed red blood cells. PBT, perioperative blood transfusion.

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