Perioperative Blood Transfusion and Radical Cystectomy: Does Timing of Transfusion Affect Bladder Cancer Mortality?
Perioperative Blood Transfusion and Radical Cystectomy: Does Timing of Transfusion Affect Bladder Cancer Mortality?
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DOI：
10.1016/j.eururo.2014.08.051
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发表时间：
2014-12-01
期刊：
影响因子：
23.4
通讯作者：
Boorjian, Stephen A.
中科院分区：
文献类型：
--
作者：
Abel, E. Jason;Linder, Brian J.;Boorjian, Stephen A.
背景资料：虽然围手术期输血（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立。目的：本研究的目的是评估术中BT是否与接受根治性膀胱切除术（RC）治疗的膀胱癌患者的不良结局相关。设计、设置和参与者：分析了来自两个独立队列的用RC治疗的膀胱癌连续患者的结果。无复发生存期，癌症特异性生存期（CSS），和总生存率进行了估计，并进行多变量分析，以评估BT时间与癌症预后的关系。在360例患者的主要队列中，241例（67%）接受了围手术期BT，包括162例术中和79例术后。接受术中BT的患者的5年CSS为44%，而接受术后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），而术后接受BT则与此无关（p = 0.60）。在1770例患者的验证队列中，1100例（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）。在接受术中BT的患者中，5年RFS（p < 0.001）和CSS（p < 0.001）显著更差。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death.Conclusions的风险无关：术中BT与膀胱癌复发和mortality.Patient摘要的风险增加：在这项研究中，输血对膀胱癌手术结果的影响进行了评估。术中输血，而不是术后输血，与较高的复发率和癌症特异性死亡率相关。(C)2014年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: While perioperative blood transfusion (BT) has been associated with adverse outcomes in multiple malignancies, the importance of BT timing has not been established.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).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. (C) 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.