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Intraoperative allogeneic blood transfusion is associated with adverse oncological outcomes in patients with surgically treated non-metastatic clear cell renal cell carcinoma

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Abstract

Background

The objective of this study was to provide more definitive information about the prognostic impact of perioperative blood transfusion (PBT) on patients with surgically treated renal cell carcinoma (RCC).

Methods

A database of 4019 patients with clear cell RCC, all of whom underwent radical or partial nephrectomy as primary therapy as part of a multi-institutional Korean collaboration between 1988 and 2015, was analyzed retrospectively. PBT was defined as transfusion of allogeneic red blood cells during surgery or postsurgical period. Receipt of a PBT, as well as the amount and time of blood transfusion (BT), was compared.

Results

Overall, 335 (8.3%) patients received a PBT: 84 received postoperative BT, 202 received intraoperative BT, and 49 received both intraoperative and postoperative BT. Patients receiving a PBT had a poor preoperative immuno-nutritional status, and aggressive tumor characteristics. Multivariate analyses identified PBT as an independent predictor of recurrence-free survival and cancer-specific survival. Prognostic impact of PBT was restricted to those with locally advanced stage (pT3–4), and who underwent radical nephrectomy. Among patients who received a PBT, intraoperative (but not postoperative) BT was a prognostic factor for survival. Among patients who received intraoperative BT, those receiving three or more transfusion units had a significantly worse survival.

Conclusion

Receipt of a PBT was an independent predictor of RFS and CSS in patients with surgically treated RCC, specifically locally advanced disease. Regarding the prognostic impact of timing or dose of PBT on survival, intraoperative BT and ≥ 3 pRBC units were associated with adverse oncological outcomes.

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Funding

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (2018R1D1A1B07043906).

Author information

Authors and Affiliations

  1. Department of Urology, Chungbuk National University College of Medicine, 1st Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, South Korea

    Ho Won Kang, Sung Pil Seo, Won Tae Kim, Seok Joong Yun, Sang-Cheol Lee, Wun-Jae Kim & Yong-June Kim

  2. Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea

    Ho Won Kang, Sung Pil Seo, Won Tae Kim, Seok Joong Yun, Sang-Cheol Lee, Wun-Jae Kim & Yong-June Kim

  3. Department of Urology, Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea

    Eu Chang Hwang

  4. Department of Urology, Korea University School of Medicine, Seoul, South Korea

    Seok Ho Kang

  5. Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Sung-Hoo Hong

  6. Department of Urology, National Cancer Center, Goyang, South Korea

    Jinsoo Chung

  7. Department of Urology, Kyungpook National University College of Medicine, Daegu, South Korea

    Tae Gyun Kwon

  8. Department of Urology, Seoul National University College of Medicine, Seoul, South Korea

    Hyeon Hoe Kim & Cheol Kwak

  9. Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam, Kyunggi-do, 463-707, South Korea

    Seok-Soo Byun

Authors
  1. Ho Won Kang
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  2. Sung Pil Seo
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Consortia

The KORCC (KOrean Renal Cell Carcinoma) Group

Contributions

Conception and study design: HWK, YJK. Acquisition of data: SPS, WTK, SJY. Statistical analysis: WTK, SJY. Drafting and writing of the manuscript: HWK. Revision and critical review of the manuscript: SCL, WJK, ECH, SHK, SHH, JC, TGK, HHK, CK, SSB, YJK. Manuscript approval: all authors.

Corresponding authors

Correspondence to Seok-Soo Byun or Yong-June Kim.

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Conflict of interest

The authors have no conflicts of interests to declare.

Ethics approval

The study complied with all applicable laws and regulations, good clinical practice, and ethical principles, as described in the Declaration of Helsinki. The study protocol was approved by the institutional review board of Chungbuk National University (approval number: GR2014-12-009). The requirement for informed consent was waived due to the retrospective nature of the study.

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Kang, H.W., Seo, S.P., Kim, W.T. et al. Intraoperative allogeneic blood transfusion is associated with adverse oncological outcomes in patients with surgically treated non-metastatic clear cell renal cell carcinoma. Int J Clin Oncol 25, 1551–1561 (2020). https://doi.org/10.1007/s10147-020-01694-x

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  • DOI: https://doi.org/10.1007/s10147-020-01694-x

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