Introduction

Administration of blood transfusion (BT) has been associated with a decrease in survival expectancies in patients treated with radical cystectomy (RC). However, mechanisms associated to this relation are unknown. To test the postulated immunosuppressive effect mediated by BT in RC patients. Specifically, we evaluated if the usage of BT may influence risk and pattern of distant recurrences development after RC.

Methods

we evaluated 1,081 contemporary patients with clinically non metastatic BCa with available follow-up and recurrence site information, treated with RC and pelvic lymph node dissection (PLND) at a single tertiary care referral center (testing cohort) between_x000D_ 1990 and 2013. Findings from the first dataset were subsequently evaluated in an independent cohort composed of 433 patients who were treated with RC and PLND for clinically non-metastatic BCa between 1988 and 2003. Distant recurrences were separetely evaluated for the two studied cohort. Cox regression analyses evaluating the risk of developing distant recurrence after RC were built.

Results

In the primary cohort composed by 1,081 patients 445 (41.2%) received a perioperative BT. The median follow up was 52 months_x000D_ (Interquartile range: 44-61 months). Overall, 277 (25.6%) patients incurred in distant recurrence during follow up period. In the second cohort composed by 433 patients treated at a single institution 183 (42.3%) patients received perioperative BT. The median follow up was 83 months (Interquartile range: 75-91 months). Distant recurrence during the follow up period were recorded in 127 (28.3%) patients. One, three and five-years distant recurrence rates were 81% vs. 85%, 65% vs. 70% and 60% vs. 68% for patients who received intraoperative vs. no BT transfusion (p=0.03). One, three and five-years distant recurrence rates were 81% vs. 85%, 64% vs. 70% and 53% vs. 68% for patients who received postoperative vs. no BT transfusion (p=0.4). Similar findings were observed in the validation studied cohort (all p ?0.05). At multivariable analyses predicting distant recurrences, BT were not related to an increased risk to incur in distant recurrence (all p?0.2) or different recurrence patterns in both studied cohorts.

Conclusions

BT administration in RC patients is not associated with different pattern or higher rates of distant recurrences when compared to patients who not received BT. New data are needed to investigate mechanisms behind the association between BT and survival in RC patients.

Funding

none