title: The prognostic impact of perioperative blood transfusion on survival in patients with bladder urothelial carcinoma treated with radical cystectomy.
abstract: OBJECTIVE
  The aim of our study was to assess the influence of perioperative blood transfusion (PBT) on survival outcomes following radical cystectomy (RC) and pelvic lymph node dissection (PLND).
  
  
  METHODS
  We reviewed and analyzed the clinical data of 432 patients who underwent RC for bladder cancer from 1991 to 2012. PBT was defined as the transfusion of allogeneic red blood cells during RC or postoperative hospitalization.
  
  
  RESULTS
  Of all patients, 315 patients (72.9%) received PBT. On multivariate logistic regression analysis, female gender (p=0.015), a lower preoperative hemoglobin level (p=0.003), estimated blood loss>800 mL (p<0.001), and performance of neoadjuvant chemotherapy (p<0.001) were independent risk factors related to requiring perioperative transfusions. The receipt of PBT was associated with increased overall mortality (hazard ratio, 1.91; 95% confidence interval, 1.25-2.94; p=0.003) on univariate analysis, but its association was not confirmed by multivariate analysis (p=0.058). In transfused patients, a transfusion of >4 packed red blood cell units was an independent predictor of overall survival (p=0.007), but not in cancer specific survival.
  
  
  CONCLUSIONS
  Our study was not conclusive to detect a clear association between PBT and survival after RC. However, the efforts should be made to continue limiting the overuse of transfusion especially in patients who are expected to have a high probability of PBT, such as females and those with a low preoperative hemoglobin level and history of neoadjuvant chemotherapy.
authors: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
authors: Joong Sub
authors: JS
authors: Lee
authors: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
authors: Hyung Suk
authors: HS
authors: Kim
authors: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
authors: Chang Wook
authors: CW
authors: Jeong
authors: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
authors: Cheol
authors: C
authors: Kwak
authors: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
authors: Hyeon Hoe
authors: HH
authors: Kim
authors: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
authors: Ja Hyeon
authors: JH
authors: Ku
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000379:methods / Q000401:mortality; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000473:pathology / Q000601:surgery; D019990:Perioperative Care / Q000379:methods; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery
keywords: Blood transfusion; Cystectomy; Survival; Urinary bladder neoplasms