Introduction

Previous studies have been inconclusive whether the receipt of perioperative allogeneic blood transfusion (PBT) independently confers an impaired oncological outcome in patients treated with radical cystectomy (RC) for high-grade recurrent or muscle-invasive bladder cancer. Aim of this study was to evaluate the effect of perioperative PBT at RC on recurrence-free (RFS) and overall survival (OS) and cancer-specific (CSM) and other-cause mortality (OM) in a contemporary European multicenter cohort.

Methods

We relied on the Prospective Multicenter Radical Cystectomy Series (PROMETRICS), which includes data of 679 patients undergoing RC at 18 European tertiary care centers in 2011. Patients with missing information on PBT, American Society of Anesthesiologists (ASA) physical status, follow-up, survival data, or disease recurrence, as well as clinically metastatic patients were excluded from further analyses._x000D_ The association between PBT and oncological outcomes, as well as OCM was assessed using Cox and logistic regression analyses. Imbalances in clinicopathological features of patients receiving PBT vs. patients not receiving PBT were mitigated using conventional adjusting as well as inverse probability of treatment weighting (IPTW).

Results

The final population consisted of 525 patients with a median follow-up of 26 months (IQR: 21-30 months) of whom 275 patients (52.4%) received PBT. The two groups (PBT vs. no PBT) differed significantly with respect to most clinicopathological features including perioperative blood loss (median: 1000ml; IQR: 650-1600ml vs. median: 570ml; IQR: 400-800ml)._x000D_ Independent predictors of receipt of PBT in multivariate logistic regression analysis were sex (odds ratio (OR)=4.66; 95% confidence interval (CI)=[2.34-9.29]; p<0.001), body mass index (OR=0.92; 95% CI=[0.87-0.97]; p=0.003), type of urinary diversion (OR=0.40; 95% CI=[0.22-0.75]; p=0.004), estimated blood loss (OR=1.29; 95% CI=[1.21-1.39]; p<0.001), and any complication within 30 days (OR=3.00; 95% CI=[1.75-5.15]; p<0.001)._x000D_ Unweighted and unadjusted survival analyses revealed a significant increase in cumulative incidences of CSM and OCM in the two groups (p=0.017 and p<0.001, respectively)._x000D_ After IPTW-adjustment, those differences no longer held true. PBT was not associated with RFS (HR=0.92; 95% CI=[0.53-1.59]; p=0.76), OS (HR=1.07; 95% CI=[0.56-2.04]; p=0.84), CSM (sub-HR=1.09; 95% CI=[0.62-1.93]; p=0.76) and OCM (sub-HR=1.02; 95% CI=[0.27-3.84]; p=0.95) in IPTW-adjusted Cox regression and competing-risks regression analyses. The same held true in conventional multivariate Cox and competing-risks regression analyses, where pathological tumor stage and lymphovascular invasion were the only independent predictors of CSM (HR=3.71, 95% CI=[2.06-6.68], p<0.001 and HR=2.49, 95% CI=[1.43-4.33], p<0.001) as well as disease recurrence (HR=4.48, 95% CI=[2.45-8.16], p<0.001 and HR=2.76, 95% CI=[1.56-4.87], p<0.001)._x000D_

Conclusions

This study could not determine an adverse impact of PBT on oncological outcome and overall survival after adjusting for differences in patient characteristics._x000D_

Funding

none