title: The effect of intra- and postoperative allogenic blood transfusion on patients' survival undergoing radical cystectomy for urothelial carcinoma of the bladder.
abstract: OBJECTIVE
  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).
  
  
  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.
authors: Department of Urology, St. Josef Medical Center, University of Regensburg, Landshuterstrasse 65, 93053, Regensburg, Germany, Michael.Gierth@klinik.uni-regensburg.de.
authors: M
authors: M
authors: Gierth
authors: A
authors: A
authors: Aziz
authors: H M
authors: HM
authors: Fritsche
authors: M
authors: M
authors: Burger
authors: W
authors: W
authors: Otto
authors: F
authors: F
authors: Zeman
authors: M T
authors: MT
authors: Pawlik
authors: E
authors: E
authors: Hansen
authors: M
authors: M
authors: May
authors: S
authors: S
authors: Denzinger
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications / Q000401:mortality / Q000601:surgery; D001803:Blood Transfusion; D002277:Carcinoma / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D019459:Urothelium