title: The impact of perioperative blood transfusion on survival following radical cystectomy for urothelial carcinoma.
abstract: BACKGROUND
  Perioperative blood transfusion (PBT) has been shown to contribute to cancer progression and mortality.  This study sought to determine the impact of PBT during radical cystectomy on cancer-specific survival (CSS) and overall survival (OS).
  
  
  METHODS
  The Columbia University Urologic Oncology Database was reviewed for patients who underwent a RC from 1989 to 2010 (n = 638).  PBT was defined as non-autologous packed red blood cells (PRBC) received during the same hospital stay as the radical cystectomy.  Clinical and pathological variables were compared between the cohorts and survival analysis was performed with the Kaplan-Meier and Cox-regression methods.  The primary outcomes were CSS and OS.
  
  
  RESULTS
  Of 638 patients identified, 209 patients (32.8%) underwent PBT with an average of 2.21 ± 1.66 units transfused PRBC.  Mean age was 68.1 ± 11.2 years; median follow up was 25.5 months (range 1-164 months).  The number of units of PRBC transfused was inversely associated with OS (HR 1.12; p = 0.008) and CSS (HR 1.12; p = 0.049) on univariable analysis.  Additionally, Kaplan-Meier analysis demonstrated a significant difference in OS (p = 0.0211) in patients who received more units of PRBC.  However, on multivariable analysis, the number of units of PRBC transfused was not an independent predictor of outcome for CSS (p = 0.300) or OS (p = 0.246).
  
  
  CONCLUSIONS
  Each additional unit of PRBC received during radical cystectomy is associated with a decrease in survival.  However, after controlling for clinical and pathologic factors which predict survival, PBT does not have an independent affect upon CSS or OS.
authors.affiliation: Department of Urology, Squier Urological Clinic, Columbia University Medical Center, New York, New York 10032, USA.
authors.forename: Neda
authors.initials: N
authors.lastname: Sadeghi
authors.forename: Gina M
authors.initials: GM
authors.lastname: Badalato
authors.forename: Gregory
authors.initials: G
authors.lastname: Hruby
authors.forename: Max
authors.initials: M
authors.lastname: Kates
authors.forename: James M
authors.initials: JM
authors.lastname: McKiernan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059035:Perioperative Period; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D019459:Urothelium / Q000473:pathology