title: Timing of blood transfusion and not ABO blood type is associated with survival in patients treated with radical cystectomy for nonmetastatic bladder cancer: Results from a single high-volume institution.
abstract: Perioperative transfusions have been recently associated to poor outcomes as an indirect consequence of immune-hematological changes related to transfusion itself and blood type. We tested the role of blood transfusion on cancer-specific mortality (CSM) and overall mortality (OM), considering the effect of ABO system, Rh factor, and timing of transfusions.
  
  
  
  The study focused on 728 patients with bladder cancer treated with radical cystectomy at a single tertiary care referral center between January 1995 and August 2013 with complete ABO blood type information. Kaplan-Meier analysis was used to assess the effect of transfusions, stratified according to ABO type and Rh factor, on CSM and OM. The same endpoints were tested in Cox regression models, after adjusting for all available confounders.
  
  
  
  A total of 341 (46.8%), 277 (38.0%), 83 (11.4%), and 27 (3.7%) patients had blood type O, A, B and AB, respectively. Overall, 630 (86.5%) and 98 (13.5%) patients were Rh-and Rh+, respectively. At a median follow-up time of 65 months, 225 (30.9%) and 282 (38.7%) patients recorded CSM and OM, respectively. At univariable analyses, ABO blood type and Rh status were not associated to either CSM or OM (all P>0.2). Similar results were observed when ABO blood type and Rh factor were tested in multivariable models (all P>0.3). Conversely, Charlson score, preoperative hemoglobin, number of nodes removed, pathological T stage, and number of positive nodes were associated to both CSM and OM (all P<0.05). Interestingly, intraoperative transfusion (all P<0.03) but not the administration of blood units in the postoperative period (P>0.05) was associated with an increase of CSM and OM.
  
  
  
  Although ABO type or Rh factor or both were associated with several adverse outcomes in many cancers, we were not able to confirm this association in bladder cancer. Based on our results, the effect of transfusion on survival is independent by ABO type but is associated to the timing of blood supply administration.
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy. Electronic address: marco.moschini87@gmail.com.
authors: Marco
authors: M
authors: Moschini
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy.
authors: Marco
authors: M
authors: Bianchi
authors: Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors: Martina Sofia
authors: MS
authors: Rossi
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors: Paolo
authors: P
authors: Dell׳Oglio
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors: Giorgio
authors: G
authors: Gandaglia
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors: Nicola
authors: N
authors: Fossati
authors: Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
authors: Agostino
authors: A
authors: Mattei
authors: Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy.
authors: Rocco
authors: R
authors: Damiano
authors: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors: Andrea
authors: A
authors: Salonia
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors: Francesco
authors: F
authors: Montorsi
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors: Alberto
authors: A
authors: Briganti
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors: Renzo
authors: R
authors: Colombo
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors: Andrea
authors: A
authors: Gallina
mesh_terms: D000017:ABO Blood-Group System; D000368:Aged; D001803:Blood Transfusion; D015653:Cystectomy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery* / Q000628:therapy*
chemical_list: D000017:ABO Blood-Group System
keywords: ABO type; Bladder cancer; Blood type; Intraoperative transfusion; Radical cystectomy; Transfusion