Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA.
Eur Urol. 2014 Dec;66(6):1139-47. doi: 10.1016/j.eururo.2014.08.051. Epub 2014 Sep 4.
While perioperative blood transfusion (BT) has been associated with adverse outcomes in multiple malignancies, the importance of BT timing has not been established.
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).
DESIGN, SETTING, AND PARTICIPANTS: Outcomes from two independent cohorts of consecutive patients with bladder cancer treated with RC were analyzed.
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.
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.
Intraoperative BT is associated with increased risk of bladder cancer recurrence and mortality.
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.
围手术期输血（BT）与多种恶性肿瘤的不良结局相关，但 BT 时机的重要性尚未确定。
本研究旨在评估在接受根治性膀胱切除术（RC）治疗的膀胱癌患者中，术中 BT 是否与更差的癌症结局相关。
设计、设置和参与者：分析了两个独立队列的连续膀胱癌患者接受 RC 治疗的结果。
估计无复发生存率、癌症特异性生存率（CSS）和总生存率，并进行多变量分析以评估 BT 时机与癌症结局的关联。
在 360 名患者的主要队列中，241 名（67%）接受了围手术期 BT，其中 162 名术中接受，79 名术后接受。术中接受 BT 的患者 5 年 CSS 为 44%，而术后接受 BT 的患者为 64%（p=0.0005）。多变量分析后，术中 BT 与癌症死亡风险增加相关（风险比[HR]：1.93；p=0.02），而术后 BT 则不然（p=0.60）。在 1770 名患者的验证队列中，1100 名（62%）接受了围手术期 BT，中位术后随访时间为 11 年（四分位距：8.0-15.7）。术中接受 BT 的患者 5 年 RFS（p<0.001）和 CSS（p<0.001）明显更差。术中 BT 与复发（HR：1.45；p=0.001）、癌症特异性死亡率（HR：1.55；p=0.0001）和全因死亡率（HR：1.40；p<0.0001）独立相关。术后 BT 与疾病复发或癌症死亡风险无关。
术中 BT 与膀胱癌复发和死亡率增加相关。
在这项研究中，评估了输血对膀胱癌手术结果的影响。术中输血，而不是术后输血，与更高的复发率和癌症特异性死亡率相关。
