PD16-03 THE IMPACT OF PERIOPERATIVE BLOOD TRANSFUSION ON SURVIVAL FOLLOWING NEPHRECTOMY FOR NON METASTATIC RENAL CELL CARCINOMA

Abstract

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 2014PD16-03 THE IMPACT OF PERIOPERATIVE BLOOD TRANSFUSION ON SURVIVAL FOLLOWING NEPHRECTOMY FOR NON METASTATIC RENAL CELL CARCINOMA Brian Linder, R. Houston Thompson, Bradley Leibovich, John Cheville, Christine Lohse, Dennis Gastineau, and Stephen Boorjian Brian LinderBrian Linder More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Bradley LeibovichBradley Leibovich More articles by this author , John ChevilleJohn Cheville More articles by this author , Christine LohseChristine Lohse More articles by this author , Dennis GastineauDennis Gastineau More articles by this author , and Stephen BoorjianStephen Boorjian More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1148AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives While receipt of a perioperative blood transfusion (PBT) has been associated with an increased risk of mortality for a number of cancers, the relationship between PBT and survival following nephrectomy for kidney cancer has not been well established. Determining the impact of PBT on postoperative outcomes is important for optimizing patient management. Herein, we evaluated the association of perioperative blood transfusion with survival following nephrectomy for renal cell carcinoma (RCC). Methods We identified 2318 patients who underwent partial or radical nephrectomy at Mayo Clinic between 1990 and 2006 for non-metastatic RCC. PBT was defined as transfusion of allogenic red blood cells during surgery or postoperative hospitalization. Survival was estimated using Kaplan Meier method and compared with the log−rank test. Cox proportional hazards regression models were used to evaluate the association of PBT with outcome. Results A total of 498 patients (21%) received a PBT. The median number of units transfused was 3 (IQR 2, 5). Patients receiving a PBT were significantly older at surgery (p<0.001), more likely to be female (p<0.001), with more frequent symptomatic presentation (p<0.001), worse ECOG performance status (p<0.001), and more frequent adverse pathologic features such as high nuclear grade (p<0.001), locally-advanced tumor stage (p<0.001) and lymph node invasion (p<0.001). Median postoperative follow−up was 9.1 years. Receipt of a PBT was associated with adverse 5 year cancer−specific (68% versus 92%;p<0.001) and overall (56% versus 82%;p<0.001) survival. On multivariate analysis (Table), PBT remained associated with a higher risk of death from any cause (HR 1.23;p=0.02). Moreover, among patients who received a PBT, an increasing number of units transfused was independently associated with increased all-cause mortality (HR 1.08; p=0.001). Conclusions PBT is associated with a significantly increased risk of mortality following nephrectomy. While external validation is needed, continued efforts to minimize the use of blood products in these patients are warranted. Multivariate analysis of factors associated with death from kidney cancer and all-cause mortality following nephrectomy for RCC Death from Any Cause Death from Kidney Cancer Variable HR 95% CI p-value HR 95% CI p-value Year of surgery 0.98 0.97, 1.00 0.03 0.95 0.93, 0.98 < 0.001 Age at surgery 1.63 1.53, 1.75 < 0.001 1.14 1.03, 1.27 0.02 Gender (ref male) 1.27 1.09, 1.48 0.002 0.85 0.66, 1.09 0.2 Symptomatic presentation 1.17 0.98, 1.39 0.08 1.24 0.95, 1.62 0.12 ECOG performance status (ref 0) 2.26 1.89, 2.71 < 0.001 1.96 1.40, 2.73 < 0.001 Body mass index 1.02 0.95, 1.09 0.58 1.01 0.91, 1.13 0.82 Pre-operative hemoglobin 0.96 0.93, 1.00 0.07 1.04 0.98, 1.11 0.16 Receipt of PBT 1.23 1.04, 1.46 0.02 1.15 0.87, 1.53 0.31 Pathologic tumor stage 1.07 1.01, 1.13 0.02 1.32 1.22, 1.42 < 0.001 Tumor size 1.02 1.00, 1.05 0.06 1.04 1.00, 1.07 0.03 Histology (ref papillary/chromophobe) 1.41 1.18, 1.68 < 0.001 2.25 1.53, 3.29 < 0.001 pN1 1.91 1.39, 2.62 < 0.001 2.13 1.48, 3.05 < 0.001 Nuclear grade (ref 1-2) 3 1.30 1.11, 1.53 0.002 2.99 2.13, 4.19 < 0.001 4 2.21 1.58, 3.10 < 0.001 4.80 2.89, 7.95 < 0.001 Coagulative tumor necrosis 1.46 1.23, 1.74 < 0.001 2.26 1.73, 2.95 < 0.001 Sarcomatoid differentiation 1.69 1.08, 2.65 0.02 1.59 0.96, 2.64 0.08 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e487 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Brian Linder More articles by this author R. Houston Thompson More articles by this author Bradley Leibovich More articles by this author John Cheville More articles by this author Christine Lohse More articles by this author Dennis Gastineau More articles by this author Stephen Boorjian More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...