Buchner Alexander, Grimm Tobias, Schneevoigt Birte-Swantje, Wittmann Georg, Kretschmer Alexander, Jokisch Friedrich, Grabbert Markus, Apfelbeck Maria, Schulz Gerald, Gratzke Christian, Stief Christian G, Karl Alexander
a Department of Urology , Ludwig-Maximilians-Universität München , Munich , Germany.
b Department of Transfusion Medicine , Ludwig-Maximilians-Universität München , Munich , Germany.
Scand J Urol. 2017 Apr;51(2):130-136. doi: 10.1080/21681805.2017.1295399. Epub 2017 Mar 23.
The aim of the present study was to determine the influence of intraoperative and postoperative blood transfusion on cancer-specific outcome.
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.
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).
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.
本研究旨在确定术中和术后输血对癌症特异性结局的影响。
收集了2004年至2014年间722例行根治性膀胱切除术治疗膀胱尿路上皮癌（UCB）患者的随访数据。中位随访时间为26个月（四分位间距12 - 61个月）。根据术中和术后输血量以及不同肿瘤分期分析结局。主要终点是膀胱切除术后的癌症特异性生存（CSS）。采用Kaplan-Meier分析及对数秩检验和Cox回归模型。
36%（263/722）的患者接受了术中输血，18%（132/722）的患者接受了术后输血。接受和未接受术中输血的患者，5年CSS分别为48%和67%（p < 0.001）。接受和未接受术后输血的患者，5年CSS分别为48%和63%（p < 0.001）。输注红细胞（RBC）单位数量[术中：风险比（HR）= 1.08，95%置信区间（CI）1.01 - 1.15，p = 0.023；术后：HR = 1.14，95% CI 1.07 - 1.21，p < 0.001]是CSS的独立预后因素。在有利亚组（pT1肿瘤、血红蛋白≥13mg/dl，p = 0.004）和高手术量外科医生亚组（n = 244，p < 0.001）中也发现了输血的剂量依赖性负面影响。
在这项回顾性研究中，根治性膀胱切除术中及术后输血是CSS的独立预后因素。因此，应努力减少膀胱切除患者术中和术后输血的必要性。
