Perioperative blood transfusion is not an independent predictor of survival after radical cystectomy
Previous literature recommended reduction of perioperative blood transfusion (PBT) post-cystectomy due to its association with inferior survival. This study investigates the effect of PBT on overall (OS) and disease-free survival (DFS) in patients who underwent radical cystectomy for bladder cancer.
Data from 479 patients who underwent radical cystectomy at a single institution from January 2010 to December 2016 were analyzed. PBT was defined as packed red blood cell transfusion within 30 days of surgical date. Major complications were defined as Clavien III or higher. Primary end points were OS and DFS. Patient-specific variables and outcomes were analyzed in relation to administration of PBT. Multivariable analyses were performed using Cox proportional hazards. Kaplan-Meier curves were constructed to evaluate associations between PBT and survival outcomes.
64% of patients received PBT. Transfused patients were significantly older and more likely to have a Charlson Comorbidity Index (CCI) of 3 or greater. PBTs were associated with open (vs. robotic) approach, longer operative times, and higher estimated blood loss. Transfused patients stayed, on average, 2 days longer post-cystectomy (p<0.001) and were more likely to have major complications within 30 days of surgery (p=0.005). Higher pathological stage (T2-T4) and variant histology were more frequently observed in patients who received PBT. As shown in figure 1, estimated OS and DFS were significantly worse in transfused patients (p=0.002 and p=0.021, respectively). On multivariate analysis, PBT was not an independent predictor of OS [hazard ratio (HR) 1.28, p=0.15] and DFS (HR 1.19, p=0.39) when controlling for age, BMI, CCI, variant histology, neoadjuvant chemotherapy and T stage.</p>
PBT was associated with decreased OS and DFS but was not an independent predictor of survival. PBT serves as a clinical surrogate for older and frailer patients with more advanced disease.