Investig Clin Urol.  2020 Mar;61(2):136-145. 10.4111/icu.2020.61.2.136.

Impact of perioperative blood transfusion on oncologic outcomes in patients with nonmetastatic renal cell carcinoma treated with curative nephrectomy: A retrospective analysis of a large, single-institutional cohort

Affiliations
  • 1Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Urology, Dongguk University Ilsan Medical Center, Goyang, Korea. willybimish@naver.com

Abstract

PURPOSE
To evaluate the impact of perioperative blood transfusion (PBT) on oncologic outcomes after surgery in patients with nonmetastatic renal cell carcinoma (RCC).
MATERIALS AND METHODS
This retrospective review included 2,329 patients who underwent partial or radical nephrectomy for localized RCC in a single institution from 2000 to 2014. PBT was defined as transfusion of allogeneic packed red blood cells (pRBCs) during nephrectomy or within the preoperative or postoperative hospitalization period. Oncologic outcomes of interest were recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS).
RESULTS
PBT was performed in 275 patients (11.8%). In the multivariable logistic regression analysis, symptomatic presentation, advanced age at surgery, higher preoperative serum creatinine, and lower preoperative hemoglobin were independent preoperative risk factors for PBT (all p<0.05). Kaplan-Meier plots revealed that transfused patients showed poorer 5-year RFS (65.1% vs. 91.2%, p<0.001), OS (71.4% vs. 92.8%, p<0.001), and CSS (74.0% vs. 95.5%, p<0.001) than nontransfused patients. However, in the multivariable Cox regression analyses, PBT was not significantly associated with RFS, OS, or CSS. In multivariable analyses involving transfused patients only (n=275), an higher number of pRBC units was an independent predictor of worse OS (hazard ratio [HR], 1.043; 95% confidence interval [CI], 1.008-1.078; p=0.016) and CSS (HR, 1.066; 95% CI, 1.033-1.100; p<0.001).
CONCLUSIONS
The results of this study are inconclusive in that the influence of PBT on survival outcomes could not be determined in the multivariate analysis. However, increasing pRBC units in transfused patients might be a concern in light of worse OS and CSS. Therefore, efforts to limit PBT overuse seem necessary to improve postoperative survival in patients with RCC.

Keyword

Blood transfusion; Carcinoma, renal cell; Nephrectomy; Recurrence; Survival

MeSH Terms

Blood Transfusion*
Carcinoma, Renal Cell*
Cohort Studies*
Creatinine
Erythrocytes
Hospitalization
Humans
Logistic Models
Multivariate Analysis
Nephrectomy*
Recurrence
Retrospective Studies*
Risk Factors
Creatinine

Figure

  • Fig. 1 Kaplan–Meier curves for each survival outcome according to perioperative blood transfusion (PBT) in the entire study cohort. (A) Recurrence-free survival. (B) Overall survival. (C) Cancer-specific survival.


Reference

1. Rawn J. The silent risks of blood transfusion. Curr Opin Anaesthesiol. 2008; 21:664–668.
Article
2. Cata JP, Wang H, Gottumukkala V, Reuben J, Sessler DI. Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions. Br J Anaesth. 2013; 110:690–701.
Article
3. Acheson AG, Brookes MJ, Spahn DR. Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg. 2012; 256:235–244.
4. Luan H, Ye F, Wu L, Zhou Y, Jiang J. Perioperative blood transfusion adversely affects prognosis after resection of lung cancer: a systematic review and a meta-analysis. BMC Surg. 2014; 14:34.
Article
5. Mavros MN, Xu L, Maqsood H, Gani F, Ejaz A, Spolverato G, et al. Perioperative blood transfusion and the prognosis of pancreatic cancer surgery: systematic review and meta-analysis. Ann Surg Oncol. 2015; 22:4382–4391.
Article
6. Sun C, Wang Y, Yao HS, Hu ZQ. Allogeneic blood transfusion and the prognosis of gastric cancer patients: systematic review and meta-analysis. Int J Surg. 2015; 13:102–110.
Article
7. Xun Y, Tian H, Hu L, Yan P, Yang K, Guo T. The impact of perioperative allogeneic blood transfusion on prognosis of hepatocellular carcinoma after radical hepatectomy: a systematic review and meta-analysis of cohort studies. Medicine (Baltimore). 2018; 97:e12911.
8. Vamvakas EC, Blajchman MA. Transfusion-related immunomodulation (TRIM): an update. Blood Rev. 2007; 21:327–348.
Article
9. Lee JS, Kim HS, Jeong CW, Kwak C, Kim HH, Ku JH. The prognostic impact of perioperative blood transfusion on survival in patients with bladder urothelial carcinoma treated with radical cystectomy. Korean J Urol. 2015; 56:295–304.
Article
10. Wang YL, Jiang B, Yin FF, Shi HQ, Xu XD, Zheng SS, et al. Perioperative blood transfusion promotes worse outcomes of bladder cancer after radical cystectomy: a systematic review and meta-analysis. PLoS One. 2015; 10:e0130122.
Article
11. Chalfin HJ, Liu JJ, Gandhi N, Feng Z, Johnson D, Netto GJ, et al. Blood transfusion is associated with increased perioperative morbidity and adverse oncologic outcomes in bladder cancer patients receiving neoadjuvant chemotherapy and radical cystectomy. Ann Surg Oncol. 2016; 23:2715–2722.
Article
12. Kim JK, Kim HS, Park J, Jeong CW, Ku JH, Kim HH, et al. Perioperative blood transfusion as a significant predictor of biochemical recurrence and survival after radical prostatectomy in patients with prostate cancer. PLoS One. 2016; 11:e0154918.
Article
13. Pushan Z, Manbiao C, Sulai L, Jun L, Ruidong Z, Hanshen Y. The impact of perioperative blood transfusion on survival and recurrence after radical prostatectomy for prostate cancer: A systematic review and meta-analysis. J Cancer Res Ther. 2018; 14:Supplement. S701–S707.
14. Linder BJ, Thompson RH, Leibovich BC, Cheville JC, Lohse CM, Gastineau DA, et al. The impact of perioperative blood transfusion on survival after nephrectomy for non-metastatic renal cell carcinoma (RCC). BJU Int. 2014; 114:368–374.
Article
15. Tsivian M, Abern MR, Tsivian E, Sze C, Jibara G, Rampersaud EN Jr, et al. Effect of blood transfusions on oncological outcomes of surgically treated localized renal cell carcinoma. Urol Oncol. 2018; 36:362.e1–362.e7.
Article
16. Abu-Ghanem Y, Dotan Z, Zilberman DE, Kaver I, Ramon J. Intraoperative but not postoperative blood transfusion adversely affect cancer recurrence and survival following nephrectomy for renal cell carcinoma. Sci Rep. 2019; 9:1160.
Article
17. Iwata T, Kimura S, Foerster B, Abufaraj M, Karakiewicz PI, Preisser F, et al. Perioperative blood transfusion affects oncologic outcomes after nephrectomy for renal cell carcinoma: a systematic review and meta-analysis. Urol Oncol. 2019; 37:273–281.
Article
18. Volpe A, Patard JJ. Prognostic factors in renal cell carcinoma. World J Urol. 2010; 28:319–327.
Article
19. Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015; 67:913–924.
Article
20. Monk TG, Goodnough LT. Blood conservation strategies to minimize allogeneic blood use in urologic surgery. Am J Surg. 1995; 170:6A Suppl. 69S–73S.
Article
21. Saito J, Masui K, Noguchi S, Nakai K, Tamai Y, Midorikawa Y, et al. The efficacy of acute normovolemic hemodilution for preventing perioperative allogeneic blood transfusion in gynecological cancer patients. J Clin Anesth. 2020; 60:42–43.
Article
22. Abel EJ, Linder BJ, Bauman TM, Bauer RM, Thompson RH, Thapa P, et al. Perioperative blood transfusion and radical cystectomy: does timing of transfusion affect bladder cancer mortality? Eur Urol. 2014; 66:1139–1147.
Article
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