Perioperative Blood Transfusion Is Associated with Worse Survival in Patients Undergoing Radical Cystectomy after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Not Transfused | Transfused * | Total | p-Value | ||
---|---|---|---|---|---|
N (% of total pt) | 341 (35.9%) | 608 (64.1%) | 949 (100%) | ||
Median units transfused (IQR) | N/A | 3.0 (IQR 4–2) | N/A | ||
Mean Age | (STD) | 62.8 (9.3) | 67.0 (23.1) | 65.5 (19.4) | <0.001 |
Sex (n, %) | Male | 288 (84.5%) | 444 (73.1%) | 732 (77.2%) | <0.001 |
Female | 53 (15.5%) | 163 (26.9%) | 216 (22.8%) | ||
Race (n, %) | Caucasian | 250 (73.3%) | 472 (77.8%) | 722 (76.1%) | 0.056 |
Black | 38 (11.1%) | 40 (6.5%) | 78 (8.2%) | ||
Asian | 5 (1.5%) | 10 (1.6%) | 15 (1.6%) | ||
Hispanic | 3 (0.9%) | 12 (1.9%) | 15 (1.6%) | ||
Other | 11 (3.2%) | 25 (4.1%) | 36 (3.8%) | ||
Unknown | 34 (9.9%) | 48 (7.9%) | 83 (8.7%) | ||
Smoker (n, %) | Never | 100 (30.0%) | 176 (29.7%) | 276 (32.2%) | 0.892 |
Prior | 164 (49.3%) | 300 (50.7%) | 464 (54.2%) | ||
Current | 69 (20.7%) | 116 (19.6%) | 185 (13.6%) | ||
BMI (n, %) | ≤25 kg/m2 | 112 (32.8%) | 211 (34.8%) | 323 (34.1%) | 0.593 |
26–30 | 65 (19.1%) | 126 (20.8%) | 191 (20.0%) | ||
31–35 | 75 (21.9%) | 117 (19.2%) | 192 (20.0%) | ||
≥36 | 40 (11.7%) | 61 (10.0%) | 101 (10.7%) | ||
Unknown | 49 (14.4%) | 92 (15.2%) | 141 (14.9%) | ||
Clinical T-stage (n, %) | T2 | 207 (60.7%) | 322 (53.1%) | 529 (55.8%) | 0.026 |
T3 | 100 (29.4%) | 192 (31.6%) | 292 (30.8%) | ||
T4a | 34 (9.9%) | 93 (15.3%) | 127 (13.4%) | ||
ECOG ** (n, %) | 0 | 168 (49.3%) | 247 (40.7%) | 415 (43.7%) | 0.082 |
1 | 58 (17.0%) | 133 (21.9%) | 191 (20.1%) | ||
2 | 7 (2.1%) | 25 (4.1%) | 32 (3.4%) | ||
3 | 0 | 5 (0.8%) | 5 (0.5%) | ||
Unknown | 108 (31.7%) | 197 (32.5%) | 306 (50.4%) | ||
Pre-operative hemoglobin (g/dL), mean (STD) | 13.43 (14.1) | 15.87 (21.5) | 15.01 (19.3) | 0.002 | |
Platelets, mean (STD) | 231.5 (77.4) | 229.6 (103.5) | 230.3 (95.2) | 0.164 |
Total Population | Included Participants | ||
---|---|---|---|
N (% of total pt) | 1865 (100%) | 949 (50.9%) | |
Mean Age | (STD) | 64.03 (15.614) | 65.5 (19.4) |
Sex (n, %) | Male | 1219 (76.8%) | 732 (77.2%) |
Female | 369 (23.2%) | 216 (22.8%) | |
Race (n, %) | Caucasian | 1231 (66.0%) | 722 (76.1%) |
Black | 106 (5.7%) | 78 (8.2%) | |
Asian | 25 (1.3%) | 15 (1.6%) | |
Hispanic | 22 (1.2%) | 15 (1.6%) | |
Other | 4 (0.2%) | 36 (3.8%) | |
Unknown | 477 (25.6%) | 83 (8.7%) | |
Smoker (n, %) | Never | 485 (30.9%) | 276 (32.2%) |
Prior | 770 (49.1%) | 464 (54.2%) | |
Current | 313 (20.0%) | 185 (13.6%) | |
BMI (n,%) | ≤25 kg/m2 | 383 (20.5%) | 323 (34.1%) |
26–30 | 399 (21.5%) | 191 (20.0%) | |
31–35 | 182 (9.7%) | 192 (20.0%) | |
≥36 | 103 (5.5%) | 101 (10.7%) | |
Unknown | 283 (42.8%) | 141 (14.9%) | |
ECOG (n, %) | 0 | 654 (35.0%) | 415 (43.7%) |
1 | 290 (15.5%) | 191 (20.1%) | |
2 | 42 (2.4%) | 32 (3.4%) | |
3 | 9 (0.5%) | 5 (0.5%) | |
Unknown | 870 (46.6%) | 306 (50.4%) | |
Pre-operative hemoglobin (g/dL), mean (STD) | 15.45 (21.5) | 15.01 (19.3) | |
Platelets, mean (STD) | 237.25 (100.8) | 230.3 (95.2) |
Not Transfused | Transfused | Total | p-Value | ||
---|---|---|---|---|---|
NAC Regimen (n, %) | DDMVAC | 61 (18.0%) | 108 (18.0%) | 169 (18.0%) | 0.040 |
MVAC | 35 (10.3%) | 105 (17.5%) | 140 (14.9%) | ||
Gem Cis | 178 (52.5%) | 297 (49.5%) | 475 (50.6%) | ||
Gem Carbo | 54 (15.9%) | 79 (13.2%) | 133 (14.2%) | ||
Other cisplatin-containing | 11 (3.2%) | 11 (1.8%) | 22 (2.3%) | ||
NAC number of cycles (n, %) | <3 | 44 (12.9%) | 77 (12.7%) | 121 (12.7%) | 0.026 |
3 | 146 (42.8%) | 213 (35.1%) | 359 (37.8%) | ||
4 | 119 (34.9%) | 240 (39.5%) | 359 (37.8%) | ||
>4 | 32 (9.4%) | 77 (12.7%) | 110 (11.6%) | ||
Pathologic T-stage (n, %) | ypT0 | 100 (29.3%) | 129 (21.3%) | 229 (24.2%) | 0.004 (LR 0.001) |
ypTa | 5 (1.5%) | 10 (1.6%) | 15 (1.6%) | ||
ypTis | 42 (12.3%) | 61 (10.0%) | 103 (10.9%) | ||
ypT1 | 23 (6.7%) | 28 (4.6%) | 51 (5.4%) | ||
ypT2 | 56 (16.4%) | 108 (17.8%) | 164 (17.3%) | ||
ypT3 | 79 (23.2%) | 159 (26.2%) | 238 (39.2%) | ||
ypT4 | 35 (10.3%) | 99 (16.3%) | 134 (14.1%) | ||
ypTx | 0 | 12 (1.9%) | 12 (1.3%) | ||
Unknown | 1 (0.3%) | 1 (0.2%) | 2 (0.2%) | ||
Pathologic N-Stage (n, %) | ypN0 | 248 (73.2%) | 420 (69.2%) | 668 (70.6%) | 0.721 (LR 0.715) |
ypN1 | 33 (9.7%) | 66 (10.9%) | 99 (10.5%) | ||
ypN2 | 37 (10.9%) | 83 (13.7%) | 120 (12.7%) | ||
ypN3 | 14 (4.1%) | 26 (4.3%) | 40 (4.2%) | ||
ypNx | 0 | 0 | 0 | ||
Response to NAC (n, %) | ypT0N0 | 89 (26.1%) | 116 (19.1%) | 205 (21.6%) | <0.001 (LR 17.619) |
ypTa/Tis/T1N0 | 60 (17.6%) | 87 (14.3%) | 147 (15.5%) | ||
ypT2-T4Nany or ypTanyN1-3 | 182 (53.4%) | 388 (63.9%) | 570 (60.1%) | ||
Unknown | 10 (2.9%) | 16 (2.6%) | 27 (2.8%) | ||
Pre-operative hemoglobin (g/dL), mean (STD) | 13.43 (14.1) | 15.87 (21.5) | 15.01 (19.3) |
Hazard Ratio | 95% Confidence Interval | p-Value | |
---|---|---|---|
Age | |||
Continuous | 1.012 | 0.999–1.026 | 0.080 |
Sex | |||
Ref: Male | |||
Female | 0.752 | 0.537–1.054 | 0.098 |
Clinical T-stage | |||
Ref: T2 | |||
T3 | 1.264 | 0.936–1.707 | 0.127 |
T4 | 0.924 | 0.617–1.383 | 0.701 |
Smoker | |||
Ref: Never smoker | |||
Past Smoker | 1.015 | 0.740–1.393 | 0.926 |
Current Smoker | 1.025 | 0.689–1.525 | 0.903 |
Pre-cystectomy Hemoglobin | |||
Continuous | 0.997 | 0.988–1.006 | 0.542 |
Blood Transfusion | |||
Ref: No | |||
Yes | 1.529 | 1.126–2.077 | 0.007 |
Hazard Ratio | 95% Confidence Interval | p-Value | |
---|---|---|---|
Age | |||
Continuous | 1.007 | 0.993–1.022 | 0.318 |
Sex | |||
Ref: Male | |||
Female | 0.666 | 0.464–0.957 | 0.028 |
Clinical T-stage | |||
Ref: T2 | |||
T3 | 1.482 | 1.075–2.043 | 0.018 |
T4 | 1.030 | 0.675–1.572 | 0.892 |
Smoker | |||
Ref: No | |||
Past Smoker | 1.014 | 0.717–1.453 | 0.938 |
Current Smoker | 1.155 | 0.760–1.753 | 0.500 |
Pre-cystectomy Hemoglobin | |||
Continuous | 0.994 | 0.981–1.006 | 0.319 |
Blood Transfusion | |||
Continuous | 1.089 | 1.049–1.132 | <0.001 |
Hazard Ratio | 95% Confidence Interval | p-Value | |
---|---|---|---|
Age | |||
Continuous | 1.008 | 0.993–1.022 | 0.306 |
Sex | |||
Ref: Male | |||
Female | 0.650 | 0.451–0.938 | 0.021 |
Clinical T-stage | |||
Ref: T2 | |||
T3 | 1.481 | 1.074–2.041 | 0.017 |
T4 | 0.999 | 0.650–1.535 | 0.996 |
Smoker | |||
Ref: No | |||
Past Smoker | 1.025 | 0.724–1.452 | 0.887 |
Current Smoker | 1.177 | 0.773–1.790 | 0.448 |
Pre-cystectomy Hemoglobin | |||
Continuous | 0.994 | 0.981–1.006 | 0.314 |
Blood Transfusion | |||
Ref: None | |||
Intraoperative | 1.121 | 1.043–1.204 | 0.002 |
Post-operative | 1.080 | 1.032–1.130 | 0.001 |
Hazard Ratio | 95% Confidence Interval | p-Value | |
---|---|---|---|
Age | |||
Continuous | 1.012 | 0.987–1.037 | 0.361 |
Sex | |||
Ref: Male | |||
Female | 0.746 | 0.388–1.435 | 0.380 |
Clinical T-stage | |||
Ref: T2 | |||
T3 | 2.427 | 1.441–4.089 | 0.001 |
T4 | 1.020 | 0.399–2.067 | 0.968 |
Smoker | |||
Ref: No | 0.764 | 0.554–1.054 | 0.101 |
Pre-cystectomy Hemoglobin | |||
Continuous | 1.186 | 1.036–1.358 | 0.013 |
Blood Transfusion | |||
Ref: None | |||
Post-operative | 1.079 | 0.653–1.78 | 0.767 |
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Ladner, T.; Black, A.J.; Zargar, H.; Wright, J.L.; Thorpe, A.C.; Morgan, T.M.; Holzbeierlein, J.M.; Cookson, M.S.; Jacobsen, N.-E.; Fairey, A.S.; et al. Perioperative Blood Transfusion Is Associated with Worse Survival in Patients Undergoing Radical Cystectomy after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer. Soc. Int. Urol. J. 2024, 5, 202-213. https://doi.org/10.3390/siuj5030031
Ladner T, Black AJ, Zargar H, Wright JL, Thorpe AC, Morgan TM, Holzbeierlein JM, Cookson MS, Jacobsen N-E, Fairey AS, et al. Perioperative Blood Transfusion Is Associated with Worse Survival in Patients Undergoing Radical Cystectomy after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer. Société Internationale d’Urologie Journal. 2024; 5(3):202-213. https://doi.org/10.3390/siuj5030031
Chicago/Turabian StyleLadner, Tessa, Anna J. Black, Homayoun Zargar, Jonathan L. Wright, Andrew C. Thorpe, Todd M. Morgan, Jeff M. Holzbeierlein, Michael S. Cookson, Niels-Erik Jacobsen, Adrian S. Fairey, and et al. 2024. "Perioperative Blood Transfusion Is Associated with Worse Survival in Patients Undergoing Radical Cystectomy after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer" Société Internationale d’Urologie Journal 5, no. 3: 202-213. https://doi.org/10.3390/siuj5030031
APA StyleLadner, T., Black, A. J., Zargar, H., Wright, J. L., Thorpe, A. C., Morgan, T. M., Holzbeierlein, J. M., Cookson, M. S., Jacobsen, N. -E., Fairey, A. S., Dinney, C. P. N., Mir, M. C., Krabbe, L. -M., Montgomery, J. S., Vasdev, N., Yu, E. Y., Xylinas, E., Stephenson, A. J., Shah, J. B., ... Black, P. C. (2024). Perioperative Blood Transfusion Is Associated with Worse Survival in Patients Undergoing Radical Cystectomy after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer. Société Internationale d’Urologie Journal, 5(3), 202-213. https://doi.org/10.3390/siuj5030031