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Perioperative blood transfusion and radical cystectomy: does timing of transfusion affect bladder cancer mortality?
Abel, E Jason; Linder, Brian J; Bauman, Tyler M; Bauer, Rebecca M; Thompson, R Houston; Thapa, Prabin; Devon, Octavia N; Tarrell, Robert F; Frank, Igor; Jarrard, David F; Downs, Tracy M; Boorjian, Stephen A.
Afiliação
  • Abel EJ; Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Electronic address: abel@urology.wisc.edu.
  • Linder BJ; Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA.
  • Bauman TM; Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
  • Bauer RM; Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
  • Thompson RH; Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA.
  • Thapa P; Department of Health Science Research, Mayo Medical School and Mayo Clinic, Rochester, MN, USA.
  • Devon ON; Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
  • Tarrell RF; Department of Health Science Research, Mayo Medical School and Mayo Clinic, Rochester, MN, USA.
  • Frank I; Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA.
  • Jarrard DF; Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
  • Downs TM; Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
  • Boorjian SA; Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA.
Eur Urol ; 66(6): 1139-47, 2014 Dec.
Article em En | MEDLINE | ID: mdl-25194909
ABSTRACT

BACKGROUND:

While perioperative blood transfusion (BT) has been associated with adverse outcomes in multiple malignancies, the importance of BT timing has not been established.

OBJECTIVE:

The objective of this study was to evaluate whether intraoperative BT is associated with worse cancer outcomes in bladder cancer patients treated with radical cystectomy (RC). DESIGN, SETTING, AND

PARTICIPANTS:

Outcomes from two independent cohorts of consecutive patients with bladder cancer treated with RC were analyzed. OUTCOME MEASUREMENTS AND STATISTICAL

ANALYSIS:

Recurrence-free survival, cancer-specific survival (CSS), and overall survival were estimated and multivariate analyses were performed to evaluate the association of BT timing with cancer outcomes. RESULTS AND

LIMITATIONS:

In the primary cohort of 360 patients, 241 (67%) received perioperative BT, including 162 intraoperatively and 79 postoperatively. Five-year CSS was 44% among patients who received an intraoperative BT versus 64% for patients who received postoperative BT (p=0.0005). After multivariate analysis, intraoperative BT was associated with an increased risk of cancer mortality (hazard ratio [HR] 1.93; p=0.02), while receipt of postoperative BT was not (p=0.60). In the validation cohort of 1770 patients, 1100 (62%) received perioperative BT with a median postoperative follow-up of 11 yr (interquartile range 8.0-15.7). Five-year RFS (p<0.001) and CSS (p<0.001) were significantly worse among patients who received an intraoperative BT. Intraoperative BT was independently associated with recurrence (HR 1.45; p=0.001), cancer-specific mortality (HR 1.55; p=0.0001), and all-cause mortality (HR 1.40; p<0.0001). Postoperative BT was not associated with risk of disease recurrence or cancer death.

CONCLUSIONS:

Intraoperative BT is associated with increased risk of bladder cancer recurrence and mortality. PATIENT

SUMMARY:

In this study, the effects of blood transfusion on bladder cancer surgery outcomes were evaluated. Intraoperative blood transfusion, but not postoperative transfusion, was associated with higher rates of recurrence and cancer-specific mortality.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cuidados Pós-Operatórios / Neoplasias da Bexiga Urinária / Transfusão de Sangue / Carcinoma / Cuidados Intraoperatórios / Recidiva Local de Neoplasia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2014 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cuidados Pós-Operatórios / Neoplasias da Bexiga Urinária / Transfusão de Sangue / Carcinoma / Cuidados Intraoperatórios / Recidiva Local de Neoplasia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2014 Tipo de documento: Article