The relationship between perioperative blood transfusion and overall mortality in patients undergoing radical cystectomy for bladder cancer.
The relationship between perioperative blood transfusion and overall mortality in patients undergoing radical cystectomy for bladder cancer.
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DOI：
10.1016/j.urolonc.2011.07.012
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发表时间：
2013-08
期刊：
影响因子：
--
通讯作者：
Cookson MS
中科院分区：
文献类型：
--
作者：
Morgan TM;Barocas DA;Chang SS;Phillips SE;Salem S;Clark PE;Penson DF;Smith JA Jr;Cookson MS
围手术期输血（PBT）和肿瘤结局之间的关系存在争议。在接受结肠癌和其他几种实体恶性肿瘤手术的患者中，PBT与死亡风险增加相关。然而，泌尿外科文献中缺乏关于这一主题的数据。我们试图评估PBT是否影响膀胱癌患者根治性化疗（RC）后的总生存率。回顾性分析了777例连续接受RC治疗的膀胱尿路上皮癌患者的病历。PBT定义为RC期间或术后住院期间输注红细胞。主要结局是总生存期。采用卡方检验比较临床和病理变量，并进行考克斯多变量生存分析。共有323例患者（41.6%）接受PBT。在单变量分析中，PBT与总死亡率增加相关（HR 1.40，95%CI 1.11-1.78）。此外，在非转换logistic回归模型中（HR，95%CI 1.01-1.36）证明了独立关联，但在使用限制性三次样条的模型中（HR 1.03，95%CI 0.77-1.38）未证明。第一个模型的c指数为0.78，第二个模型为0.79。在一个传统的多变量模型中，反映了普通外科文献中应用于这个问题的模型，我们证明了PBT和RC后总死亡率之间的相关性。然而，在第二个统计模型中没有观察到这种关系。考虑到PBT研究中充分控制混杂因素的复杂性，前瞻性研究将有必要充分阐明PBT相关的独立风险。
The relationship between perioperative blood transfusion (PBT) and oncologic outcomes is controversial. In patients undergoing surgery for colon cancer and several other solid malignancies, PBT has been associated with an increased risk of mortality. Yet, the urologic literature has a paucity of data addressing this topic. We sought to evaluate whether PBT affects overall survival following radical cystectomy (RC) for patients with bladder cancer. The medical records of 777 consecutive patients undergoing RC for urothelial carcinoma of the bladder were reviewed. PBT was defined as transfusion of red blood cells during RC or within the postoperative hospitalization. The primary outcome was overall survival. Clinical and pathologic variables were compared using chi-squared tests, and Cox multivariate survival analyses were performed. A total of 323 patients (41.6%) underwent PBT. In the univariate analysis, PBT was associated with increased overall mortality (HR 1.40, 95%CI 1.11–1.78). Additionally, an independent association was demonstrated in a nontransformed logistic regression model(HR, 95%CI 1.01–1.36) but not in a model utilizing restricted cubic splines(HR 1.03, 95%CI 0.77–1.38). The c-index was 0.78 for the first model and 0.79 for the second. In a traditional multivariate model, mirroring those that have been applied to this question in the general surgery literature, we demonstrated an association between PBT and overall mortality after RC. However, this relationship is not observed in a second statistical model. Given the complex nature of adequately controlling for confounding factors in studies of PBT, prospective study will be necessary to fully elucidate the independent risks associated with PBT.
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