title: The impact of perioperative blood transfusion on cancer recurrence and survival following radical cystectomy.
abstract: BACKGROUND
  While the receipt of a perioperative blood transfusion (PBT) has been associated with an increased risk of mortality for a number of malignancies, the relationship between PBT and survival following radical cystectomy (RC) for bladder cancer (BCa) has not been well established.
  
  
  OBJECTIVE
  To evaluate the association of PBT with disease recurrence and mortality following RC.
  
  
  METHODS
  We identified 2060 patients who underwent RC at the Mayo Clinic between 1980 and 2005. PBT was defined as transfusion of allogenic red blood cells during RC or postoperative hospitalization.
  
  
  METHODS
  Survival was estimated using the Kaplan-Meier method and was compared with the log-rank test. Cox proportional hazard regression models were used to evaluate the association of PBT with outcome, controlling for clinicopathologic variables.
  
  
  CONCLUSIONS
  A total of 1279 patients (62%) received PBT. The median number of units transfused was 2 (interquartile range [IQR]: 2-4). Patients receiving PBT were significantly older (median: 69 yr vs 66 yr; p<0.0001), had a worse Eastern Cooperative Oncology Group performance status (p<0.0001), and were more likely to have muscle-invasive tumors (56% vs 49%; p = 0.004). Median postoperative follow-up was 10.9 yr (IQR: 7.9-15.7). Receipt of PBT was associated with significantly worse 5-yr recurrence-free survival (58% vs 64%; p = 0.01), cancer-specific survival (59% vs 72%; p<0.001), and overall survival (45% vs 63%; p<0.001). On multivariate analyses, PBT remained associated with significantly increased risks of postoperative tumor recurrence (hazard ratio [HR]: 1.20; p = 0.04), death from BCa (HR: 1.31; p = 0.003), and all-cause mortality (HR: 1.27; p = 0.0002). Among patients who received PBT, an increasing number of units transfused was independently associated with increased cancer-specific mortality (HR: 1.07; p<0.0001) and all-cause mortality (HR: 1.05; p<0.0001). Limitations include selection bias and lack of standardized transfusion criteria.
  
  
  CONCLUSIONS
  We found that PBT is associated with significantly increased risks of cancer recurrence and mortality following RC. While external validation is required, continued efforts to reduce the use of blood products in these patients are warranted.
authors: Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA.
authors: Brian J
authors: BJ
authors: Linder
authors: Igor
authors: I
authors: Frank
authors: John C
authors: JC
authors: Cheville
authors: Matthew K
authors: MK
authors: Tollefson
authors: R Houston
authors: RH
authors: Thompson
authors: Robert F
authors: RF
authors: Tarrell
authors: Prabin
authors: P
authors: Thapa
authors: Stephen A
authors: SA
authors: Boorjian
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000009:adverse effects / Q000401:mortality; D018450:Disease Progression; D018572:Disease-Free Survival; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D008910:Minnesota; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D019990:Perioperative Care; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*