TY - JOUR
T1 - Perioperative blood transfusion and radical cystectomy
T2 - Does timing of transfusion affect bladder cancer mortality?
AU - Abel, E. Jason
AU - Linder, Brian J.
AU - Bauman, Tyler M.
AU - Bauer, Rebecca M.
AU - Thompson, R. Houston
AU - Thapa, Prabin
AU - Devon, Octavia N.
AU - Tarrell, Robert F.
AU - Frank, Igor
AU - Jarrard, David F.
AU - Downs, Tracy M.
AU - Boorjian, Stephen A.
N1 - Publisher Copyright:
© 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved. -absp. Objective The objective of this study was to evaluate whether intraoperative BT is associated with worse cancer outcomes in bladder cancer patients treated with radical cystectomy (RC).
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - Background While perioperative blood transfusion (BT) has been associated with adverse outcomes in multiple malignancies, the importance of BT timing has not been established.Design, setting, and participants Outcomes from two independent cohorts of consecutive patients with bladder cancer treated with RC were analyzed.Outcome measurements and statistical analysis Recurrence-free survival, cancer-specific survival (CSS), and overall survival were estimated and multivariate analyses were performed to evaluate the association of BT timing with cancer outcomes.Results and limitations In the primary cohort of 360 patients, 241 (67%) received perioperative BT, including 162 intraoperatively and 79 postoperatively. Five-year CSS was 44% among patients who received an intraoperative BT versus 64% for patients who received postoperative BT (p = 0.0005). After multivariate analysis, intraoperative BT was associated with an increased risk of cancer mortality (hazard ratio [HR]: 1.93; p = 0.02), while receipt of postoperative BT was not (p = 0.60). In the validation cohort of 1770 patients, 1100 (62%) received perioperative BT with a median postoperative follow-up of 11 yr (interquartile range: 8.0-15.7). Five-year RFS (p < 0.001) and CSS (p < 0.001) were significantly worse among patients who received an intraoperative BT. Intraoperative BT was independently associated with recurrence (HR: 1.45; p = 0.001), cancer-specific mortality (HR: 1.55; p = 0.0001), and all-cause mortality (HR: 1.40; p < 0.0001). Postoperative BT was not associated with risk of disease recurrence or cancer death.Conclusions Intraoperative BT is associated with increased risk of bladder cancer recurrence and mortality.Patient summary In this study, the effects of blood transfusion on bladder cancer surgery outcomes were evaluated. Intraoperative blood transfusion, but not postoperative transfusion, was associated with higher rates of recurrence and cancer-specific mortality.
AB - Background While perioperative blood transfusion (BT) has been associated with adverse outcomes in multiple malignancies, the importance of BT timing has not been established.Design, setting, and participants Outcomes from two independent cohorts of consecutive patients with bladder cancer treated with RC were analyzed.Outcome measurements and statistical analysis Recurrence-free survival, cancer-specific survival (CSS), and overall survival were estimated and multivariate analyses were performed to evaluate the association of BT timing with cancer outcomes.Results and limitations In the primary cohort of 360 patients, 241 (67%) received perioperative BT, including 162 intraoperatively and 79 postoperatively. Five-year CSS was 44% among patients who received an intraoperative BT versus 64% for patients who received postoperative BT (p = 0.0005). After multivariate analysis, intraoperative BT was associated with an increased risk of cancer mortality (hazard ratio [HR]: 1.93; p = 0.02), while receipt of postoperative BT was not (p = 0.60). In the validation cohort of 1770 patients, 1100 (62%) received perioperative BT with a median postoperative follow-up of 11 yr (interquartile range: 8.0-15.7). Five-year RFS (p < 0.001) and CSS (p < 0.001) were significantly worse among patients who received an intraoperative BT. Intraoperative BT was independently associated with recurrence (HR: 1.45; p = 0.001), cancer-specific mortality (HR: 1.55; p = 0.0001), and all-cause mortality (HR: 1.40; p < 0.0001). Postoperative BT was not associated with risk of disease recurrence or cancer death.Conclusions Intraoperative BT is associated with increased risk of bladder cancer recurrence and mortality.Patient summary In this study, the effects of blood transfusion on bladder cancer surgery outcomes were evaluated. Intraoperative blood transfusion, but not postoperative transfusion, was associated with higher rates of recurrence and cancer-specific mortality.
KW - Bladder cancer
KW - Intraoperative blood transfusion
KW - Outcomes
KW - Transfusion
KW - Urothelial carcinoma
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U2 - 10.1016/j.eururo.2014.08.051
DO - 10.1016/j.eururo.2014.08.051
M3 - Article
C2 - 25194909
AN - SCOPUS:84910068640
SN - 0302-2838
VL - 66
SP - 1139
EP - 1147
JO - European urology
JF - European urology
IS - 6
ER -