Abstract
Purpose
Radical cystectomy (RC) can be associated with significant blood loss. Allogenic blood transfusion (ABT) may alter disease outcome because of a theoretical immunomodulatory effect. We evaluated the effects of ABT on overall survival (OS) and progression-free survival (PFS) of patients undergoing RC for urothelial carcinoma of the bladder (UCB).
Materials and methods
This is a retrospective single-center study of 350 consecutive patients of a university health center with a median follow-up of 70.1 month. All patients underwent RC and pelvic lymph node dissection. The effect of ABT on OS and PFS was analyzed using univariable and multivariable Cox proportional hazards models.
Results
The overall ABT rate was 63 % (n = 219), with intraoperative blood transfusion and postoperative blood transfusion being performed in 183 patients (52 %) and 99 patients (28 %), respectively. Preoperative anemia was detected in 156 patients (45 %) with median estimated blood loss of 800 ml (IQR: 500–1,200). ABT was associated with significant decrease of OS and PFS in multivariable analyses (p < 0.001), whereas patients’ prognosis worsened the more packed red blood cells (PRBC) were transfused (p < 0.001). The study is limited in part due to its retrospective design.
Conclusions
We found that ABT and the number of PRBC transfused are associated with poor prognosis for UCB patients undergoing RC, whereas preoperative anemia had no influence on survival. This emphasizes the importance of surgeon’s awareness for a strict indication for ABT. A prospective study will be necessary to evaluate the independent risks associated with ABT during surgical treatments.
Similar content being viewed by others
References
Hollenbeck BK, Miller DC, Taub D et al. (2005) Identifying risk factors for potentially avoidable complications following radical cystectomy. J Urol 174:1231–1237; discussion 1237
Chang SS, Smith JA Jr, Wells N et al (2001) Estimated blood loss and transfusion requirements of radical cystectomy. J Urol 166:2151–2154
Busch OR, Hop WC, Hoynck van Papendrecht MA et al (1993) Blood transfusions and prognosis in colorectal cancer. N Engl J Med 328:1372–1376
Park KI, Kojima O, Tomoyoshi T (1997) Intra-operative autotransfusion in radical cystectomy. Br J Urol 79:717–721
Pisters LL, Wajsman Z (1992) Use of predeposit autologous blood and intraoperative autotransfusion in urologic cancer surgery. Urology 40:211–215
Klein HG (1995) Allogeneic transfusion risks in the surgical patient. Am J Surg 170:21S–26S
Gantt CL (1981) Red blood cells for cancer patients. Lancet 2:363
Ojima T, Iwahashi M, Nakamori M et al (2009) Association of allogeneic blood transfusions and long-term survival of patients with gastric cancer after curative gastrectomy. J Gastrointest Surg 13:1821–1830
Shiba H, Ishida Y, Wakiyama S et al (2009) Negative impact of blood transfusion on recurrence and prognosis of hepatocellular carcinoma after hepatic resection. J Gastrointest Surg 13:1636–1642
Wang CC, Iyer SG, Low JK et al (2009) Perioperative factors affecting long-term outcomes of 473 consecutive patients undergoing hepatectomy for hepatocellular carcinoma. Ann Surg Oncol 16:1832–1842
Eickhoff JH, Gote H, Baeck J (1991) Peri-operative blood transfusion in relation to tumour recurrence and death after surgery for prostatic cancer. Br J Urol 68:608–611
Babjuk M, Oosterlinck W, Sylvester R et al (2010) Guidelines on TaT1 (non-muscle invasive) Bladder Cancer. EAU
Stenzl A, Cowan NC, De Santis M et al (2010) Guidelines on muscle-invasive and metastatic bladder cancer. EAU
McLean E, Cogswell M, Egli I et al (2009) Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutr 12:444–454
Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383
May M, Bastian PJ, Brookmann-May S et al (2012) External validation of a risk model to predict recurrence-free survival after radical cystectomy in patients with pathological tumor stage T3N0 urothelial carcinoma of the bladder. J Urol 187:1210–1214
Mackenzie G (1982) The statistical-analysis of failure time data—Kalbfleisch, Jd, Prentice, Rl. Statistician 31:278–278
Taniguchi Y, Okura M (2003) Prognostic significance of perioperative blood transfusion in oral cavity squamous cell carcinoma. Head Neck 25:931–936
Motoyama S, Okuyama M, Kitamura M et al (2004) Use of autologous instead of allogeneic blood transfusion during esophagectomy prolongs disease-free survival among patients with recurrent esophageal cancer. J Surg Oncol 87:26–31
Tartter PI, Burrows L, Papatestas AE et al (1985) Perioperative blood transfusion has prognostic significance for breast cancer. Surgery 97:225–230
Nosotti M, Rebulla P, Riccardi D et al (2003) Correlation between perioperative blood transfusion and prognosis of patients subjected to surgery for stage I lung cancer. Chest 124:102–107
Morgan TM, Barocas DA, Chang SS et al (2013) The relationship between perioperative blood transfusion and overall mortality in patients undergoing radical cystectomy for bladder cancer. Urol Oncol 31:871–877
Ghosh S, Ahmed K, Hopkinson DN et al (2004) Pulmonary adenocarcinoma is associated with poor long-term survival after surgical resection. Effect of allogeneic blood transfusion. Cancer 101:2058–2066
Vamvakas EC, Blajchman MA (2001) Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction? Blood 97:1180–1195
Bracey AW, Radovancevic R, Riggs SA et al (1999) Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome. Transfusion 39:1070–1077
Butt ZM, Fazili A, Tan W et al (2009) Does the presence of significant risk factors affect perioperative outcomes after robot-assisted radical cystectomy? BJU Int 104:986–990
Mayr R, May M, Martini T et al (2012) Predictive capacity of four comorbidity indices estimating perioperative mortality after radical cystectomy for urothelial carcinoma of the bladder. BJU Int 110:E222–E227
Koppie TM, Serio AM, Vickers AJ et al (2008) Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer. Cancer 112:2384–2392
Acknowledgments
We thank Christopher Naisbitt for his excellent assistance.
Conflict of interest
All authors declare that no conflict of interest exists.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gierth, M., Aziz, A., Fritsche, H.M. et al. The effect of intra- and postoperative allogenic blood transfusion on patients’ survival undergoing radical cystectomy for urothelial carcinoma of the bladder. World J Urol 32, 1447–1453 (2014). https://doi.org/10.1007/s00345-014-1257-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-014-1257-x