Impact of peri-operative blood transfusion on the outcomes of patients undergoing radical cystectomy for urothelial carcinoma of the bladder

Luis A. Kluth, Evanguelos Xylinas, Malte Rieken, Maya El Ghouayel, Maxine Sun, Pierre I. Karakiewicz, Yair Lotan, Felix K H Chun, Stephen A. Boorjian, Richard K. Lee, Alberto Briganti, Morgan Rouprêt, Margit Fisch, Douglas S. Scherr, Shahrokh F. Shariat

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Abstract

Objective To determine the association between peri-operative blood transfusion (PBT) and oncological outcomes in a large multi-institutional cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). Patients and Methods We conducted a retrospective analysis of 2895 patients treated with RC for UCB. Univariable and multivariable Cox regression models were used to analyse the effect of PBT administration on disease recurrence, cancer-specific mortality, and any-cause mortality. Results Patients' median (interquartile range [IQR]) age was 67 (60, 73) years and the median (IQR) follow-up was 36.1 (15, 84) months. Patients who received PBT were more likely to have advanced disease (P < 0.001), high grade tumours (P = 0.047) and nodal metastasis (P = 0.004). PBT was associated with a higher risk of disease recurrence (P = 0.003), cancer-specific mortality (P = 0.017), and any-cause mortality (P = 0.010) in univariable, but not multivariable, analyses (P > 0.05). In multivariable analyses, pathological tumour stage, pathological nodal stage, soft tissue surgical margin, lymphovascular invasion and administration of adjuvant chemotherapy were independent predictors of disease recurrence, cancer-specific mortality and any-cause mortality (all P values <0.002). Conclusions Patients with UCB who underwent RC and received PBT had a greater risk of disease recurrence, cancer-specific mortality and any-cause mortality in univariable, but not multivariable, analysis. Although the greater need for PBT with more advanced disease is probably caused by a number of factors, including surgical and cancer-related factors, the present analysis showed that the disease characteristics rather than need for PBT led to worse outcomes.

Original languageEnglish (US)
Pages (from-to)393-398
Number of pages6
JournalBJU International
Volume113
Issue number3
DOIs
StatePublished - Mar 2014

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Cystectomy
Blood Transfusion
Urinary Bladder
Carcinoma
Mortality
Neoplasms
Recurrence
Adjuvant Chemotherapy
Proportional Hazards Models
Statistical Factor Analysis

Keywords

  • bladder carcinoma
  • blood transfusion
  • outcomes
  • prognosis
  • radical cystectomy
  • urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Kluth, L. A., Xylinas, E., Rieken, M., El Ghouayel, M., Sun, M., Karakiewicz, P. I., ... Shariat, S. F. (2014). Impact of peri-operative blood transfusion on the outcomes of patients undergoing radical cystectomy for urothelial carcinoma of the bladder. BJU International, 113(3), 393-398. https://doi.org/10.1111/bju.12439

Impact of peri-operative blood transfusion on the outcomes of patients undergoing radical cystectomy for urothelial carcinoma of the bladder. / Kluth, Luis A.; Xylinas, Evanguelos; Rieken, Malte; El Ghouayel, Maya; Sun, Maxine; Karakiewicz, Pierre I.; Lotan, Yair; Chun, Felix K H; Boorjian, Stephen A.; Lee, Richard K.; Briganti, Alberto; Rouprêt, Morgan; Fisch, Margit; Scherr, Douglas S.; Shariat, Shahrokh F.

In: BJU International, Vol. 113, No. 3, 03.2014, p. 393-398.

Research output: Contribution to journalArticle

Kluth, LA, Xylinas, E, Rieken, M, El Ghouayel, M, Sun, M, Karakiewicz, PI, Lotan, Y, Chun, FKH, Boorjian, SA, Lee, RK, Briganti, A, Rouprêt, M, Fisch, M, Scherr, DS & Shariat, SF 2014, 'Impact of peri-operative blood transfusion on the outcomes of patients undergoing radical cystectomy for urothelial carcinoma of the bladder', BJU International, vol. 113, no. 3, pp. 393-398. https://doi.org/10.1111/bju.12439
Kluth, Luis A. ; Xylinas, Evanguelos ; Rieken, Malte ; El Ghouayel, Maya ; Sun, Maxine ; Karakiewicz, Pierre I. ; Lotan, Yair ; Chun, Felix K H ; Boorjian, Stephen A. ; Lee, Richard K. ; Briganti, Alberto ; Rouprêt, Morgan ; Fisch, Margit ; Scherr, Douglas S. ; Shariat, Shahrokh F. / Impact of peri-operative blood transfusion on the outcomes of patients undergoing radical cystectomy for urothelial carcinoma of the bladder. In: BJU International. 2014 ; Vol. 113, No. 3. pp. 393-398.
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abstract = "Objective To determine the association between peri-operative blood transfusion (PBT) and oncological outcomes in a large multi-institutional cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). Patients and Methods We conducted a retrospective analysis of 2895 patients treated with RC for UCB. Univariable and multivariable Cox regression models were used to analyse the effect of PBT administration on disease recurrence, cancer-specific mortality, and any-cause mortality. Results Patients' median (interquartile range [IQR]) age was 67 (60, 73) years and the median (IQR) follow-up was 36.1 (15, 84) months. Patients who received PBT were more likely to have advanced disease (P < 0.001), high grade tumours (P = 0.047) and nodal metastasis (P = 0.004). PBT was associated with a higher risk of disease recurrence (P = 0.003), cancer-specific mortality (P = 0.017), and any-cause mortality (P = 0.010) in univariable, but not multivariable, analyses (P > 0.05). In multivariable analyses, pathological tumour stage, pathological nodal stage, soft tissue surgical margin, lymphovascular invasion and administration of adjuvant chemotherapy were independent predictors of disease recurrence, cancer-specific mortality and any-cause mortality (all P values <0.002). Conclusions Patients with UCB who underwent RC and received PBT had a greater risk of disease recurrence, cancer-specific mortality and any-cause mortality in univariable, but not multivariable, analysis. Although the greater need for PBT with more advanced disease is probably caused by a number of factors, including surgical and cancer-related factors, the present analysis showed that the disease characteristics rather than need for PBT led to worse outcomes.",
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T1 - Impact of peri-operative blood transfusion on the outcomes of patients undergoing radical cystectomy for urothelial carcinoma of the bladder

AU - Kluth, Luis A.

AU - Xylinas, Evanguelos

AU - Rieken, Malte

AU - El Ghouayel, Maya

AU - Sun, Maxine

AU - Karakiewicz, Pierre I.

AU - Lotan, Yair

AU - Chun, Felix K H

AU - Boorjian, Stephen A.

AU - Lee, Richard K.

AU - Briganti, Alberto

AU - Rouprêt, Morgan

AU - Fisch, Margit

AU - Scherr, Douglas S.

AU - Shariat, Shahrokh F.

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N2 - Objective To determine the association between peri-operative blood transfusion (PBT) and oncological outcomes in a large multi-institutional cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). Patients and Methods We conducted a retrospective analysis of 2895 patients treated with RC for UCB. Univariable and multivariable Cox regression models were used to analyse the effect of PBT administration on disease recurrence, cancer-specific mortality, and any-cause mortality. Results Patients' median (interquartile range [IQR]) age was 67 (60, 73) years and the median (IQR) follow-up was 36.1 (15, 84) months. Patients who received PBT were more likely to have advanced disease (P < 0.001), high grade tumours (P = 0.047) and nodal metastasis (P = 0.004). PBT was associated with a higher risk of disease recurrence (P = 0.003), cancer-specific mortality (P = 0.017), and any-cause mortality (P = 0.010) in univariable, but not multivariable, analyses (P > 0.05). In multivariable analyses, pathological tumour stage, pathological nodal stage, soft tissue surgical margin, lymphovascular invasion and administration of adjuvant chemotherapy were independent predictors of disease recurrence, cancer-specific mortality and any-cause mortality (all P values <0.002). Conclusions Patients with UCB who underwent RC and received PBT had a greater risk of disease recurrence, cancer-specific mortality and any-cause mortality in univariable, but not multivariable, analysis. Although the greater need for PBT with more advanced disease is probably caused by a number of factors, including surgical and cancer-related factors, the present analysis showed that the disease characteristics rather than need for PBT led to worse outcomes.

AB - Objective To determine the association between peri-operative blood transfusion (PBT) and oncological outcomes in a large multi-institutional cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). Patients and Methods We conducted a retrospective analysis of 2895 patients treated with RC for UCB. Univariable and multivariable Cox regression models were used to analyse the effect of PBT administration on disease recurrence, cancer-specific mortality, and any-cause mortality. Results Patients' median (interquartile range [IQR]) age was 67 (60, 73) years and the median (IQR) follow-up was 36.1 (15, 84) months. Patients who received PBT were more likely to have advanced disease (P < 0.001), high grade tumours (P = 0.047) and nodal metastasis (P = 0.004). PBT was associated with a higher risk of disease recurrence (P = 0.003), cancer-specific mortality (P = 0.017), and any-cause mortality (P = 0.010) in univariable, but not multivariable, analyses (P > 0.05). In multivariable analyses, pathological tumour stage, pathological nodal stage, soft tissue surgical margin, lymphovascular invasion and administration of adjuvant chemotherapy were independent predictors of disease recurrence, cancer-specific mortality and any-cause mortality (all P values <0.002). Conclusions Patients with UCB who underwent RC and received PBT had a greater risk of disease recurrence, cancer-specific mortality and any-cause mortality in univariable, but not multivariable, analysis. Although the greater need for PBT with more advanced disease is probably caused by a number of factors, including surgical and cancer-related factors, the present analysis showed that the disease characteristics rather than need for PBT led to worse outcomes.

KW - bladder carcinoma

KW - blood transfusion

KW - outcomes

KW - prognosis

KW - radical cystectomy

KW - urothelial carcinoma

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