Timing of blood transfusion and not ABO blood type is associated with survival in patients treated with radical cystectomy for nonmetastatic bladder cancer: Results from a single high-volume institution

Abstract Introduction and objectives Perioperative transfusions have been recently associated to poor outcomes as an indirect consequence of immune-hematological changes related to transfusion itself and blood type. We tested the role of blood transfusion on cancer-specific mortality (CSM) and overa...

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Published in:Urologic oncology 2016-06, Vol.34 (6), p.256.e7-256.e13
Main Authors: Moschini, Marco, M.D, Bianchi, Marco, M.D, Rossi, Martina Sofia, M.D, Dell׳Oglio, Paolo, M.D, Gandaglia, Giorgio, M.D, Fossati, Nicola, M.D, Mattei, Agostino, M.D, Damiano, Rocco, M.D, Shariat, Shahrokh F., M.D, Salonia, Andrea, M.D, Montorsi, Francesco, M.D, Briganti, Alberto, M.D, Colombo, Renzo, M.D, Gallina, Andrea, M.D
Format: Article
Language:English
Subjects:
ABO Blood-Group System
ABO type
Aged
Bladder cancer
Blood Transfusion
Blood type
Cystectomy
Female
Humans
Intraoperative transfusion
Kaplan-Meier Estimate
Male
Middle Aged
Radical cystectomy
Time Factors
Transfusion
Urinary Bladder Neoplasms - surgery
Urinary Bladder Neoplasms - therapy
Urology
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Summary:Abstract Introduction and objectives Perioperative transfusions have been recently associated to poor outcomes as an indirect consequence of immune-hematological changes related to transfusion itself and blood type. We tested the role of blood transfusion on cancer-specific mortality (CSM) and overall mortality (OM), considering the effect of ABO system, Rh factor, and timing of transfusions. Materials and methods The study focused on 728 patients with bladder cancer treated with radical cystectomy at a single tertiary care referral center between January 1995 and August 2013 with complete ABO blood type information. Kaplan-Meier analysis was used to assess the effect of transfusions, stratified according to ABO type and Rh factor, on CSM and OM. The same endpoints were tested in Cox regression models, after adjusting for all available confounders. Results A total of 341 (46.8%), 277 (38.0%), 83 (11.4%), and 27 (3.7%) patients had blood type O, A, B and AB, respectively. Overall, 630 (86.5%) and 98 (13.5%) patients were Rh−and Rh+, respectively. At a median follow-up time of 65 months, 225 (30.9%) and 282 (38.7%) patients recorded CSM and OM, respectively. At univariable analyses, ABO blood type and Rh status were not associated to either CSM or OM (all P >0.2). Similar results were observed when ABO blood type and Rh factor were tested in multivariable models (all P >0.3). Conversely, Charlson score, preoperative hemoglobin, number of nodes removed, pathological T stage, and number of positive nodes were associated to both CSM and OM (all P
ISSN:1078-1439
1873-2496
DOI:10.1016/j.urolonc.2015.12.016