Marco Moschini1, Marco Bianchi2, Giorgio Gandaglia2, Vito Cucchiara2, Stefano Luzzago2, Federico Pellucchi3, Rocco Damiano4, Vincenzo Serretta5, Alberto Briganti2, Francesco Montorsi2, Andrea Salonia2, Renzo Colombo2. 1. Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Italy; Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy. Electronic address: marco.moschini87@gmail.com. 2. Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Italy. 3. Department of Urology, AO Papa Giovanni XXIII, Bergamo, Italy. 4. Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy. 5. UO di Urologia, Policlinico Universitario "Paolo Giaccone", Palermo, Italy.
Abstract
BACKGROUND: The prognostic role of perioperative blood transfusion (PBT) in patients who underwent radical cystectomy (RC) for bladder cancer (BCa), although supported by clinical evidence, still remains to be assessed definitively. OBJECTIVE: To investigate the impact of PBT on RC patients for overall survival and after stratifying according to preoperative anemia status and to define whether the oncologic impact may be assumed to be a primary effect of PBT or attributed to the reduced preoperative hemoglobin (Hb) level. DESIGN, SETTING, AND PARTICIPANTS: A total of 1490 consecutive patients with nonmetastatic BCa who underwent RC and pelvic lymph node dissection between January 1990 and August 2013 at a single referral center entered the study. PBT and preoperative Hb levels were statistically correlated with postoperative oncologic outcomes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Kaplan-Meier analyses were used to evaluate the impact of PBT on overall mortality (OM) and cancer-specific mortality (CSM). Multivariable Cox regression analyses tested the relationship between PBT and the risk of OM and CSM in the overall population and after stratifying patients according to the severity of their anemia. RESULTS AND LIMITATIONS: A total of 580 patients (38.9%) received PBT. Mean postoperative follow-up was 125.13 mo (median: 110 mo). Overall 5- and 10-yr CSM survival rates were 58.3% and 47.6%, respectively. At multivariable Cox regression analyses, PBT could not be associated with an increased risk of either CSM or OM (all p > 0.3). Conversely, preoperative Hb levels were significantly associated with OM (hazard ratio [HR]: 0.88; confidence interval [CI], 0.83-0.95) and CSM (HR: 0.84; 95% CI, 0.77-0.95) (all p<0.001). A significant detrimental effect of PBT on OM (HR: 1.65; 95% CI, 1.08-2.52) and CSM (HR: 1.68; 95% CI, 1.04-2.70) (all p<0.03) was found in patients without preoperative anemia status. CONCLUSIONS: In nonanemic BCa patients proposed for RC, PBT is associated with a significant detrimental effect on CSM and OM. This effect seems to be attributable to the direct impact of PBT, regardless of the preoperative Hb value. PATIENT SUMMARY: In nonanemic patients proposed for radical cystectomy, a negative prognostic impact of perioperative blood transfusion should be taken into account.
BACKGROUND: The prognostic role of perioperative blood transfusion (PBT) in patients who underwent radical cystectomy (RC) for bladder cancer (BCa), although supported by clinical evidence, still remains to be assessed definitively. OBJECTIVE: To investigate the impact of PBT on RC patients for overall survival and after stratifying according to preoperative anemia status and to define whether the oncologic impact may be assumed to be a primary effect of PBT or attributed to the reduced preoperative hemoglobin (Hb) level. DESIGN, SETTING, AND PARTICIPANTS: A total of 1490 consecutive patients with nonmetastatic BCa who underwent RC and pelvic lymph node dissection between January 1990 and August 2013 at a single referral center entered the study. PBT and preoperative Hb levels were statistically correlated with postoperative oncologic outcomes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Kaplan-Meier analyses were used to evaluate the impact of PBT on overall mortality (OM) and cancer-specific mortality (CSM). Multivariable Cox regression analyses tested the relationship between PBT and the risk of OM and CSM in the overall population and after stratifying patients according to the severity of their anemia. RESULTS AND LIMITATIONS: A total of 580 patients (38.9%) received PBT. Mean postoperative follow-up was 125.13 mo (median: 110 mo). Overall 5- and 10-yr CSM survival rates were 58.3% and 47.6%, respectively. At multivariable Cox regression analyses, PBT could not be associated with an increased risk of either CSM or OM (all p > 0.3). Conversely, preoperative Hb levels were significantly associated with OM (hazard ratio [HR]: 0.88; confidence interval [CI], 0.83-0.95) and CSM (HR: 0.84; 95% CI, 0.77-0.95) (all p<0.001). A significant detrimental effect of PBT on OM (HR: 1.65; 95% CI, 1.08-2.52) and CSM (HR: 1.68; 95% CI, 1.04-2.70) (all p<0.03) was found in patients without preoperative anemia status. CONCLUSIONS: In nonanemic BCa patients proposed for RC, PBT is associated with a significant detrimental effect on CSM and OM. This effect seems to be attributable to the direct impact of PBT, regardless of the preoperative Hb value. PATIENT SUMMARY: In nonanemic patients proposed for radical cystectomy, a negative prognostic impact of perioperative blood transfusion should be taken into account.
Authors: Yannic Volz; Lennert Eismann; Paulo L Pfitzinger; Jan-Friedrich Jokisch; Alexander Buchner; Boris Schlenker; Christian G Stief; Gerald B Schulz Journal: Arab J Urol Date: 2020-12-10