Impact of Packed Red Blood Cells and Fresh Frozen Plasma Given During Radical Cystectomy and Urinary Diversion on Cancer-related Outcome and Survival: An Observational Cohort Study
Impact of Packed Red Blood Cells and Fresh Frozen Plasma Given During Radical Cystectomy and Urinary Diversion on Cancer-related Outcome and Survival: An Observational Cohort Study
复制标题
根治性膀胱切除术和尿路转流术中输入的填充红细胞和新鲜冰冻血浆对癌症相关结果和生存期的影响： 一项观察性队列研究
DOI：
10.1016/j.euf.2017.09.010
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发表时间：
2018-12-01
影响因子：
5.4
通讯作者：
Wuethrich, Patrick Y.
中科院分区：
文献类型：
--
作者：
Furrer, Marc A.;Fellmann, Adrian;Wuethrich, Patrick Y.
背景资料：输血和癌症相关的结果和死亡率之间的关系是有争议的。目的：评估围手术期使用浓缩红细胞（PRBC）和新鲜冷冻血浆（FFP）单位是否影响膀胱癌根治性膀胱切除术后的疾病进展和生存率。设计、设置和参与者：我们在2000年至2015年期间对885名膀胱癌患者进行了一项观察性单中心队列研究。围手术期输血的定义是在手术开始后24小时内需要PRBC和FFP输血。结果测量和统计分析：使用Kaplan-Meier技术和对数秩检验估计疾病无复发、癌症特异性和总生存率。结果和局限性：总共267/885例患者（23%）输血; 187/267例患者（70%）仅接受PRBC（中位数2个单位[四分位距：1 - 2]），80/267例患者（30%）接受PRBC（2 [2 - 3]）+FFP（2 [2 - 2]）。接受PRBC或PRBC + FFP与90天死亡率较高相关（7.0% vs 7.5% vs 2.9%; p = 0.016），5年无复发生存率较低（未输血92%，PRBC 74%，p = 0.005; PRBC + FFP 49%，p = 0.002），5年癌症特异性生存期（无输血74%，PRBC 60%，PRBC + FFP 49%，所有p <0.001）和5年总生存率（无输血90%，PRBC 70%，PRBC + FFP 34%，所有p <0.001）。在多变量分析中，输血可预测全因死亡率（PRBC [风险比; HR 1.610; p <0.001]和PRBC + FFP [HR 1.640; p = 0.003]）和癌症特异性死亡率（PRBC [HR 1.467; p = 0.010]和PRBC + FFP [HR 1.901; p = 0.021]）。局限性包括选择偏倚和缺乏标准化的输血criterions.Conclusions：PRBCs和FFP的管理与显着较差的癌症特异性和总生存率。接受输血的相关术前因素是新辅助化疗，术前贫血，年龄较大，和美国麻醉医师协会评分>= 3，这些因素强调了术前优化的重要性，患者接受cyberstimulation.Patient摘要：在根治性cyberstimulationis输血与较差的生存。(C)2017年欧洲泌尿外科协会。Elsevier B.V.出版，保留所有权利。
Background: The relationship between blood transfusion and cancer-related outcome and mortality is controversial.Objective: To assess if perioperative administration of packed red blood cell (PRBC) and fresh frozen plasma (FFP) units affects disease progression and survival after radical cystectomy for bladder cancer.Design, setting, and participants: We conducted an observational single-centre cohort study of a consecutive series of 885 bladder cancer patients, between 2000 and 2015. Perioperative blood transfusion was defined as need for PRBCs and FFP transfusion within the first 24 h after the beginning of surgery.Outcome measurements and statistical analysis: Disease recurrence-free, cancer-specific, and overall survival were estimated using the Kaplan-Meier technique and log-rank test.Results and limitations: A total of 267/885 patients (23%) were transfused; 187/267 patients (70%) received only PRBCs (median 2 units [interquartile range: 1-2]) and 80/267 patients (30%) received PRBCs (2 [2-3]) plus FFP (2 [2-2]). Receipt of PRBCs or PRBCs + FFP was associated with a higher 90 d mortality (7.0% vs 7.5% vs 2.9%; p = 0.016), inferior 5 yr recurrence-free survival (no transfusion 92%, PRBCs 74%, p = 0.005; PRBCs + FFP 49%, p = 0.002), 5 yr cancer-specific survival (no transfusion 74%, PRBCs 60%, PRBCs + FFP 49%, all p < 0.001), and 5 yr overall survival (no transfusion 90%, PRBCs 70%, PRBCs + FFP 34%, all p < 0.001). In multivariate analysis, blood transfusion was predictive for all-cause mortality (PRBCs [hazard ratio; HR 1.610; p < 0.001] and PRBCs + FFP [HR 1.640; p = 0.003]) and cancer-specific mortality (PRBCs [HR 1.467; p = 0.010] and PRBCs + FFP [HR 1.901; p = 0.021]). Limitations include selection bias and lack of standardised transfusion criteria.Conclusions: Administration of PRBCs and FFP was associated with significantly inferior cancer-specific and overall survival. Relevant preoperative factors for receiving blood transfusion were neoadjuvant chemotherapy, preoperative anaemia, older age, and American Society of Anesthesiologists score >= 3, and these factors emphasise the importance of preoperative optimisation of patients undergoing cystectomy.Patient summary: Blood transfusion during radical cystectomy was associated with inferior survival. (C) 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.