Société Internationale d’Urologie Journal (Jun 2024)
Perioperative Blood Transfusion Is Associated with Worse Survival in Patients Undergoing Radical Cystectomy after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer
- Tessa Ladner,
- Anna J. Black,
- Homayoun Zargar,
- Jonathan L. Wright,
- Andrew C. Thorpe,
- Todd M. Morgan,
- Jeff M. Holzbeierlein,
- Michael S. Cookson,
- Niels-Erik Jacobsen,
- Adrian S. Fairey,
- Colin P. N. Dinney,
- Maria C. Mir,
- Laura-Maria Krabbe,
- Jeffrey S. Montgomery,
- Nikhil Vasdev,
- Evan Y. Yu,
- Evanguelos Xylinas,
- Andrew J. Stephenson,
- Jay B. Shah,
- Siamak Daneshmand,
- Kamran Zargar-Shoshtari,
- Philippe E. Spiess,
- Laura S. Mertens,
- Bas W. G. van Rhijn,
- Petros Grivas,
- Wassim Kassouf,
- Marc A. Dall’Era,
- Srikala S. Sridhar,
- Jonathan S. McGrath,
- Jonathan Aning,
- Shahrokh F. Shariat,
- Trinity J. Bivalacqua,
- Scott A. North,
- Daniel A. Barocas,
- Yair Lotan,
- Peter C. Black
Affiliations
- Tessa Ladner
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Anna J. Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Homayoun Zargar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Jonathan L. Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA 98195, USA
- Andrew C. Thorpe
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage BS10 5NB, UK
- Todd M. Morgan
- Department of Urology, University of Michigan Health System, Ann Arbor, MI 48170, USA
- Jeff M. Holzbeierlein
- Department of Urology, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Michael S. Cookson
- Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK 73116, USA
- Niels-Erik Jacobsen
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB T6G 1Z2, Canada
- Adrian S. Fairey
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB T6G 1Z2, Canada
- Colin P. N. Dinney
- Department of Urology, MD Anderson Cancer Center, Houston, TX 77007, USA
- Maria C. Mir
- Department of Urology, Fundacion Instituto Valenciano de Oncologia, 46004 Valencia, Spain
- Laura-Maria Krabbe
- Department of Urology, University of Münster, 48149 Münster, Germany
- Jeffrey S. Montgomery
- Department of Urology, University of Michigan Health System, Ann Arbor, MI 48170, USA
- Nikhil Vasdev
- Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter EX2 5DW, UK
- Evan Y. Yu
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
- Evanguelos Xylinas
- Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY 75018, USA
- Andrew J. Stephenson
- Division of Urology, Rush University Medical Center, Chicago, IL 60612, USA
- Jay B. Shah
- Department of Urology, Stanford University, Stanford, CA 94305, USA
- Siamak Daneshmand
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB T6G 1Z2, Canada
- Kamran Zargar-Shoshtari
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
- Philippe E. Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
- Laura S. Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, 1066CX Amsterdam, The Netherlands
- Bas W. G. van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, 1066CX Amsterdam, The Netherlands
- Petros Grivas
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
- Wassim Kassouf
- Division of Urology, McGill University Health Center, Montreal, QC H4A 3J1, Canada
- Marc A. Dall’Era
- Department of Urology, University of California at Davis, Sacramento, CA 95819, USA
- Srikala S. Sridhar
- Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada
- Jonathan S. McGrath
- Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter EX2 5DW, UK
- Jonathan Aning
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage BS10 5NB, UK
- Shahrokh F. Shariat
- Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY 75018, USA
- Trinity J. Bivalacqua
- Division of Urology, University of Pennsylvania, Pennsylvania, PA 21210, USA
- Scott A. North
- Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada
- Daniel A. Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Yair Lotan
- Department of Urology, University of Texas Southern Medical Center, Dallas, TX 76262, USA
- Peter C. Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- DOI
- https://doi.org/10.3390/siuj5030031
- Journal volume & issue
-
Vol. 5,
no. 3
pp. 202 – 213
Abstract
Objectives: Perioperative blood transfusion (PBT) has been associated with worse survival after radical cystectomy (RC) in patients with muscle-invasive bladder cancer (MIBC). Here, we evaluated the association between PBT and survival after RC that was preceded by neoadjuvant chemotherapy (NAC). Methods: A retrospective analysis was performed on 949 patients with cT2-4aN0M0 bladder cancer who received NAC prior to RC between 2000 and 2013 at 19 centers. Kaplan–Meier estimates of overall survival (OS) were made. Presumed risk factors for OS were analyzed using Cox regression analysis. PBT was defined by the administration of any packed red blood cells during surgery or during the post-operative hospital stay. Results: A transfusion was given to 608 patients (64%). Transfused patients were more likely to have adverse clinical and pathologic parameters, including clinical stage and performance status. Transfused patients had worse OS (p = 0.01). On multivariable Cox regression, PBT was found to be independently associated with worse OS (HR 1.53 (95% CI 1.13–2.08), p = 0.007). Conclusions: PBT is common after NAC and RC, which may be linked, in part, to the anemia induced by NAC. PBT was associated with several adverse risk factors that correlate with poor outcomes after NAC and RC, and it was an independent predictor of adverse OS on multivariable analysis. Further study should determine if measures to avoid blood loss can reduce the need for PBT and thereby improve patient outcomes.
Keywords
