Dramatic impact of blood transfusion on cancer-specific survival after radical cystectomy irrespective of tumor stage.
OBJECTIVE
The aim of the present study was to determine the influence of intraoperative and postoperative blood transfusion on cancer-specific outcome.


METHODS
Follow-up data were collected from 722 patients undergoing radical cystectomy for urothelial carcinoma of the bladder (UCB) between 2004 and 2014. Median follow-up was 26 months (interquartile range 12-61 months). Outcome was analyzed in relation to the amount of intraoperative and postoperative blood transfusion and different tumor stages. The primary endpoint was cancer-specific survival (CSS) after cystectomy. Kaplan-Meier analysis with log-rank test and Cox regression models were used.


RESULTS
Intraoperative blood transfusion was given in 36% (263/722) and postoperative blood transfusion in 18% (132/722). In patients with and without intraoperative blood transfusion, 5 year CSS was 48% and 67%, respectively (p < .001). In patients with and without postoperative blood transfusion, 5 year CSS was 48% and 63%, respectively (p < .001). The number of transfused red blood cell (RBC) units [intraoperatively: hazard ratio (HR) = 1.08, 95% confidence interval (CI) 1.01-1.15, p = .023; postoperatively: HR = 1.14, 95% CI 1.07-1.21, p < .001] was an independent prognostic factor for CSS. The dose-dependent negative effect of transfusions was also found in favorable subgroups (pT1 tumor, hemoglobin ≥13 mg/dl, p = .004) and in a high-volume surgeon subgroup (n = 244, p < .001).


CONCLUSIONS
Blood transfusions during and after radical cystectomy were independent prognostic factors for CSS in this retrospective study. Therefore, efforts should be made to reduce the necessity of intraoperative and postoperative blood transfusion in cystectomy patients.
a Department of Urology , Ludwig-Maximilians-Universität München , Munich , Germany.
Alexander
A
Buchner
a Department of Urology , Ludwig-Maximilians-Universität München , Munich , Germany.
Tobias
T
Grimm
a Department of Urology , Ludwig-Maximilians-Universität München , Munich , Germany.
Birte-Swantje
BS
Schneevoigt
b Department of Transfusion Medicine , Ludwig-Maximilians-Universität München , Munich , Germany.
Georg
G
Wittmann
a Department of Urology , Ludwig-Maximilians-Universität München , Munich , Germany.
Alexander
A
Kretschmer
a Department of Urology , Ludwig-Maximilians-Universität München , Munich , Germany.
Friedrich
F
Jokisch
a Department of Urology , Ludwig-Maximilians-Universität München , Munich , Germany.
Markus
M
Grabbert
a Department of Urology , Ludwig-Maximilians-Universität München , Munich , Germany.
Maria
M
Apfelbeck
a Department of Urology , Ludwig-Maximilians-Universität München , Munich , Germany.
Gerald
G
Schulz
a Department of Urology , Ludwig-Maximilians-Universität München , Munich , Germany.
Christian
C
Gratzke
a Department of Urology , Ludwig-Maximilians-Universität München , Munich , Germany.
Christian G
CG
Stief
a Department of Urology , Ludwig-Maximilians-Universität München , Munich , Germany.
Alexander
A
Karl
D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011182:Postoperative Care; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*
Bladder cancer; blood transfusion; cystectomy; outcome