1585 THE IMPACT OF PERIOPERATIVE TRANSFUSION ON SURVIVAL CHARACTERISTICS IN SURGICALLY TREATED MEN WITH TRANSITIONAL CELL CARCINOMA OF THE BLADDER

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 20121585 THE IMPACT OF PERIOPERATIVE TRANSFUSION ON SURVIVAL CHARACTERISTICS IN SURGICALLY TREATED MEN WITH TRANSITIONAL CELL CARCINOMA OF THE BLADDER Andrew Feifer, Jennifer M. Taylor, Annalissa Piccorelli, Changhong Yu, Michael Kattan, and Bernard H. Bochner Andrew FeiferAndrew Feifer New York, NY More articles by this author , Jennifer M. TaylorJennifer M. Taylor New York, NY More articles by this author , Annalissa PiccorelliAnnalissa Piccorelli Cleveland, OH More articles by this author , Changhong YuChanghong Yu Cleveland, OH More articles by this author , Michael KattanMichael Kattan Cleveland, OH More articles by this author , and Bernard H. BochnerBernard H. Bochner New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1358AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Antigen sensitization from exogenous packed red cell transfusions has been hypothesized to impact a patients' immunological response to solid tumors. We evaluated the influence of perioperative PRBC transfusion on primarily the cumulative incidence of recurrence [CIR], and secondarily on the overall survival [OS] as well as cancer specific death [CSD] in patients with muscle invasive transitional cell carcinoma of the bladder [TCC]. METHODS We identified 2545 patients in the MSKCC prospectively maintained institutional database who underwent a radical cystectomy from 1995-2005. Perioperative transfusion was defined as within 30 days after radical cystectomy. After excluding patients with preoperative radiotherapy, non muscle-invasive disease and those who received preoperative transfusions, 2209 patients were included in the cohort. We assessed the unadjusted impact of transfusion of outcomes via the Kaplan-Meir Method for OS, and cumulative incidence for CIR and CSD. We then adjusted for patient and tumor covariates, including perioperative chemotherapy and baseline Hemoglobin, using a multivariable Cox proportional hazard regression model for OS, and multivariable competing risk regression models for CIR and CSD, and assessed the impact of PRBC transfusion on CIR, CSD and OS. RESULTS Results: Median overall survival was 4.96 years. When stratified by receipt of PRBC transfusion, the unadjusted OS was 4.62 and 6.62 years respectively for transfusion and non-transfusion groups respectively [p<.00001]. Both the unadjusted CIR and CSD were not statistically significant between groups [P = 0.065 for CIR, p=0.854 for CSD].After adjusting for tumor and patient characteristics, PRBC transfusion was an statistically significant independent predictor of CIR and OS [CIR; HR: 1.57 (1.1423,1.9882), p=0.0037, OS; HR: 0.9857 (0.8677, 1.10592) but not cancer specific death [CSD: Hr: 1.027 (0.7373, 1.14131), p=0.902]. CONCLUSIONS Conclusions: The receipt of PRBCs in the postoperative period is an independent predictor of CIR and OS in surgically treated men with bladder TCC, but not CSD. The immunologic mechanisms that may mediate this effect are in need of further investigation. While the receipt of perioperative PRBC may be unavoidable, it may also serve as an important surgical quality metric with direct impact on tumor biology. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e642 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Feifer New York, NY More articles by this author Jennifer M. Taylor New York, NY More articles by this author Annalissa Piccorelli Cleveland, OH More articles by this author Changhong Yu Cleveland, OH More articles by this author Michael Kattan Cleveland, OH More articles by this author Bernard H. Bochner New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...