title: Perioperative Blood Transfusion as a Significant Predictor of Biochemical Recurrence and Survival after Radical Prostatectomy in Patients with Prostate Cancer.
abstract: There have been conflicting reports regarding the association of perioperative blood transfusion (PBT) with oncologic outcomes including recurrence rates and survival outcomes in prostate cancer. We aimed to evaluate whether perioperative blood transfusion (PBT) affects biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS) following radical prostatectomy (RP) for patients with prostate cancer.
  
  
  
  A total of 2,713 patients who underwent RP for clinically localized prostate cancer between 1993 and 2014 were retrospectively analyzed. We performed a comparative analysis based on receipt of transfusion (PBT group vs. no-PBT group) and transfusion type (autologous PBT vs. allogeneic PBT). Univariate and multivariate Cox-proportional hazard regression analysis were performed to evaluate variables associated with BRFS, CSS, and OS. The Kaplan-Meier method was used to calculate survival estimates for BRFS, CSS, and OS, and log-rank test was used to conduct comparisons between the groups.
  
  
  
  The number of patients who received PBT was 440 (16.5%). Among these patients, 350 (79.5%) received allogeneic transfusion and the other 90 (20.5%) received autologous transfusion. In a multivariate analysis, allogeneic PBT was found to be statistically significant predictors of BRFS, CSS, and OS; conversely, autologous PBT was not. The Kaplan-Meier survival analysis showed significantly decreased 5-year BRFS (79.2% vs. 70.1%, log-rank, p = 0.001), CSS (98.5% vs. 96.7%, log-rank, p = 0.012), and OS (95.5% vs. 90.6%, log-rank, p < 0.001) in the allogeneic PBT group compared to the no-allogeneic PBT group. In the autologous PBT group, however, none of these were statistically significant compared to the no-autologous PBT group.
  
  
  
  We found that allogeneic PBT was significantly associated with decreased BRFS, CSS, and OS. This provides further support for the immunomodulation hypothesis for allogeneic PBT.
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jung Kwon
authors.initials: JK
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyung Suk
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Juhyun
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Jeong
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyun Hoe
authors.initials: HH
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019990:Perioperative Care; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis