Investig Clin Urol.  2020 Mar;61(2):136-145. 10.4111/icu.2020.61.2.136.

Impact of perioperative blood transfusion on oncologic outcomes in patients with nonmetastatic renal cell carcinoma treated with curative nephrectomy: A retrospective analysis of a large, single-institutional cohort

• Seon DY
• Kwak C
• Kim HH
• Ku JH
• Kim HS

• KMID: 2471069
• DOI: http://doi.org/10.4111/icu.2020.61.2.136

Abstract

PURPOSE
To evaluate the impact of perioperative blood transfusion (PBT) on oncologic outcomes after surgery in patients with nonmetastatic renal cell carcinoma (RCC).
MATERIALS AND METHODS
This retrospective review included 2,329 patients who underwent partial or radical nephrectomy for localized RCC in a single institution from 2000 to 2014. PBT was defined as transfusion of allogeneic packed red blood cells (pRBCs) during nephrectomy or within the preoperative or postoperative hospitalization period. Oncologic outcomes of interest were recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS).
RESULTS
PBT was performed in 275 patients (11.8%). In the multivariable logistic regression analysis, symptomatic presentation, advanced age at surgery, higher preoperative serum creatinine, and lower preoperative hemoglobin were independent preoperative risk factors for PBT (all p<0.05). Kaplan-Meier plots revealed that transfused patients showed poorer 5-year RFS (65.1% vs. 91.2%, p<0.001), OS (71.4% vs. 92.8%, p<0.001), and CSS (74.0% vs. 95.5%, p<0.001) than nontransfused patients. However, in the multivariable Cox regression analyses, PBT was not significantly associated with RFS, OS, or CSS. In multivariable analyses involving transfused patients only (n=275), an higher number of pRBC units was an independent predictor of worse OS (hazard ratio [HR], 1.043; 95% confidence interval [CI], 1.008-1.078; p=0.016) and CSS (HR, 1.066; 95% CI, 1.033-1.100; p<0.001).
CONCLUSIONS
The results of this study are inconclusive in that the influence of PBT on survival outcomes could not be determined in the multivariate analysis. However, increasing pRBC units in transfused patients might be a concern in light of worse OS and CSS. Therefore, efforts to limit PBT overuse seem necessary to improve postoperative survival in patients with RCC.

Keyword

Blood transfusion; Carcinoma, renal cell; Nephrectomy; Recurrence; Survival

MeSH Terms

Blood Transfusion*
Carcinoma, Renal Cell*
Cohort Studies*
Creatinine
Erythrocytes
Hospitalization
Humans
Logistic Models
Multivariate Analysis
Nephrectomy*
Recurrence
Retrospective Studies*
Risk Factors
Creatinine

Figure

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  Fig. 1 Kaplan–Meier curves for each survival outcome according to perioperative blood transfusion (PBT) in the entire study cohort. (A) Recurrence-free survival. (B) Overall survival. (C) Cancer-specific survival.

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