The Impact of Perioperative Blood Transfusion on Survival of Bladder Cancer Patients Submitted to Radical Cystectomy: Role of Anemia Status

Background The prognostic role of perioperative blood transfusion (PBT) in patients who underwent radical cystectomy (RC) for bladder cancer (BCa), although supported by clinical evidence, still remains to be assessed definitively. Objective To investigate the impact of PBT on RC patients for overall survival and after stratifying according to preoperative anemia status and to define whether the oncologic impact may be assumed to be a primary effect of PBT or attributed to the reduced preoperative hemoglobin (Hb) level. Design, setting, and participants A total of 1490 consecutive patients with nonmetastatic BCa who underwent RC and pelvic lymph node dissection between January 1990 and August 2013 at a single referral center entered the study. PBT and preoperative Hb levels were statistically correlated with postoperative oncologic outcomes. Outcome measurements and statistical analysis Kaplan-Meier analyses were used to evaluate the impact of PBT on overall mortality (OM) and cancer-specific mortality (CSM). Multivariable Cox regression analyses tested the relationship between PBT and the risk of OM and CSM in the overall population and after stratifying patients according to the severity of their anemia. Results and limitations A total of 580 patients (38.9%) received PBT. Mean postoperative follow-up was 125.13 mo (median: 110 mo). Overall 5- and 10-yr CSM survival rates were 58.3% and 47.6%, respectively. At multivariable Cox regression analyses, PBT could not be associated with an increased risk of either CSM or OM (all p > 0.3). Conversely, preoperative Hb levels were significantly associated with OM (hazard ratio [HR]: 0.88; confidence interval [CI], 0.83–0.95) and CSM (HR: 0.84; 95% CI, 0.77–0.95) (all p < 0.001). A significant detrimental effect of PBT on OM (HR: 1.65; 95% CI, 1.08–2.52) and CSM (HR: 1.68; 95% CI, 1.04–2.70) (all p < 0.03) was found in patients without preoperative anemia status. Conclusions In nonanemic BCa patients proposed for RC, PBT is associated with a significant detrimental effect on CSM and OM. This effect seems to be attributable to the direct impact of PBT, regardless of the preoperative Hb value. Patient summary In nonanemic patients proposed for radical cystectomy, a negative prognostic impact of perioperative blood transfusion should be taken into account.