Perioperative Blood Transfusion Promotes Worse Outcomes of Bladder Cancer after Radical Cystectomy: A Systematic Review and Meta-Analysis

You-Lin Wang, Bo Jiang, Fu-Fen Yin, Hao-Qing Shi, Xiao-Dong Xu, Shuai-Shuai Zheng, Shuai Wu, Si-Chuan Hou, You-Lin Wang, Bo Jiang, Fu-Fen Yin, Hao-Qing Shi, Xiao-Dong Xu, Shuai-Shuai Zheng, Shuai Wu, Si-Chuan Hou

Abstract

Background: Multiple studies have investigated the effect of perioperative blood transfusion (PBT) for patients with radical cystectomy (RC), but the results have been inconsistent. We conducted a systematic review and meta-analysis to investigate the relationship between PBT and the clinical outcomes of RC patients.

Methods: We searched MEDLINE, EMBASE, the Cochrane library and BIOSIS previews to identify relevant literature for studies that focused on the relationship of PBT and outcomes of patients undergoing RC. A fixed or random effects model was used in this meta-analysis to calculate the pooled hazard ratio (HR) with 95% confidence intervals (CIs).

Results: A total of 7080 patients in 6 studies matched the selection criteria. Aggregation of the data suggested that PBT in patients who underwent RC correlated with increased all-cause mortality, cancer-specific mortality and cancer recurrence. The combined HRs were 1.19 (n = 6 studies, 95% CI: 1.11-1.27, Z = 4.71, P<0.00001), 1.17 (n = 4 studies, 95% CI: 1.06-1.30, Z = 3.06, P = 0.002), 1.14 (n = 3 studies, 95% CI: 1.03-1.27, Z = 2.50, P = 0.01), respectively. The all-cause mortality associated with PBT did not vary by the characteristics of the study, including number of study participants, follow-up period and the median blood transfusion ratio of the study.

Conclusion: Our data showed that PBT significantly increased the risks of all-cause mortality, cancer-specific mortality and cancer recurrence in patients undergoing RC for bladder cancer.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram of study identification…
Fig 1. Flow diagram of study identification process.
Fig 2. Fixed-effect model forest plots of…
Fig 2. Fixed-effect model forest plots of HRs.
(A) All-cause mortality, (B) Cancer-specific mortality, (C) Cancer recurrence. SE: standard error; CI: confidence interval; IV: inverse variance.
Fig 3. Funnel plots for publication bias…
Fig 3. Funnel plots for publication bias in studies of PBT in patients with bladder cancer who underwent RC.
(A) All-cause mortality. (B) Cancer-specific mortality. (C) Cancer recurrence.

References

    1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA: a cancer journal for clinicians. 2011;61(2):69–90.
    1. Chang SS, Smith JA Jr., Wells N, Peterson M, Kovach B, Cookson MS. Estimated blood loss and transfusion requirements of radical cystectomy. The Journal of urology. 2001;166(6):2151–4.
    1. Douglas T, McLeod D. Modification of the surgical technique in radical cystectomy. Techniques in urology. 1995;2(2):73–6.
    1. Nosotti M, Rebulla P, Riccardi D, Baisi A, Bellaviti N, Rosso L, et al. Correlation between perioperative blood transfusion and prognosis of patients subjected to surgery for stage I lung cancer. CHEST Journal. 2003;124(1):102–7.
    1. Rzyman W, Dziadziuszko R, Skokowski J, Wilimski R, Raiter A, Szymanowska A, et al. The influence of blood transfusion on survival in operated non–small cell lung cancer patients. The Journal of thoracic and cardiovascular surgery. 2003;126(3):755–60.
    1. Sugita S, Sasaki A, Iwaki K, Uchida H, Kai S, Shibata K, et al. Prognosis and postoperative lymphocyte count in patients with hepatocellular carcinoma who received intraoperative allogenic blood transfusion: a retrospective study. European Journal of Surgical Oncology (EJSO). 2008;34(3):339–45.
    1. Kwon AH, Matsui Y, Kamiyama Y. Perioperative blood transfusion in hepatocellular carcinomas. Cancer. 2001;91(4):771–8.
    1. Houbiers J, Brand A, Van de Watering L, van de Velde C, Hermans J, Verwey P, et al. Randomised controlled trial comparing transfusion of leucocyte-depleted or buffy-coat-depleted blood in surgery for colorectal cancer. The Lancet. 1994;344(8922):573–8.
    1. Ydy LRA, Slhessarenko N, de Aguilar-Nascimento JE. Effect of perioperative allogeneic red blood cell transfusion on the immune-inflammatory response after colorectal cancer resection. World journal of surgery. 2007;31(10):2044–51.
    1. Boehm K, Beyer B, Tennstedt P, Schiffmann J, Budaeus L, Haese A, et al. No impact of blood transfusion on oncological outcome after radical prostatectomy in patients with prostate cancer. World journal of urology. 2014:1–6.
    1. Liu L, Wang Z, Jiang S, Shao B, Liu J, Zhang S, et al. Perioperative allogenenic blood transfusion is associated with worse clinical outcomes for hepatocellular carcinoma: a meta-analysis. PloS one. 2013;8(5):e64261 10.1371/journal.pone.0064261
    1. Linder BJ, Frank I, Cheville JC, Tollefson MK, Thompson RH, Tarrell RF, et al. The impact of perioperative blood transfusion on cancer recurrence and survival following radical cystectomy. European urology. 2013;63(5):839–45. 10.1016/j.eururo.2013.01.004
    1. Gierth M, Aziz A, Fritsche H, Burger M, Otto W, Zeman F, et al. The effect of intra-and postoperative allogenic blood transfusion on patients’ survival undergoing radical cystectomy for urothelial carcinoma of the bladder. World journal of urology. 2014:1–7.
    1. Kluth LA, Xylinas E, Rieken M, El Ghouayel M, Sun M, Karakiewicz PI, et al. Impact of peri‐operative blood transfusion on the outcomes of patients undergoing radical cystectomy for urothelial carcinoma of the bladder. BJU international. 2014;113(3):393–8. 10.1111/bju.12439
    1. Morgan TM, Barocas DA, Chang SS, Phillips SE, Salem S, Clark PE, et al., editors. The relationship between perioperative blood transfusion and overall mortality in patients undergoing radical cystectomy for bladder cancer Urologic Oncology: Seminars and Original Investigations; 2013: Elsevier.
    1. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European journal of epidemiology. 2010;25(9):603–5. 10.1007/s10654-010-9491-z
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Statistics in medicine. 2002;21(11):1539–58. Epub 2002/07/12. 10.1002/sim.1186 .
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical research ed). 1997;315(7109):629–34. Epub 1997/10/06. ; PubMed Central PMCID: PMCPmc2127453.
    1. Jahnson S, Bergstrom R, Pedersen J. Extent of blood transfusion and cancer-related mortality after cystectomy and urinary diversion for bladder cancer. British journal of urology. 1994;74(6):779–84. Epub 1994/12/01. .
    1. Suer E, Ozcan C, Gokce I, Gulpinar O, Gogus C, Turkolmez K, et al. Do blood groups have effect on prognosis of patients undergoing radical cystectomy? International urology and nephrology. 2014;46(8):1521–6. Epub 2014/03/29. 10.1007/s11255-014-0698-x .
    1. Linder BJ, Boorjian SA. Reply to Samuel Bishara and Jim Adshead's letter to the editor re: Brian J. Linder, Igor Frank, John C. Cheville, et al. The impact of perioperative blood transfusion on cancer recurrence and survival following radical cystectomy. Eur Urol 2013; 63: 839–45. European urology. 2013;64(3):e49. 10.1016/j.eururo.2013.01.004
    1. Abel EJ, Linder BJ, Bauman TM, Bauer RM, Thompson RH, Thapa P, et al. Perioperative Blood Transfusion and Radical Cystectomy: Does Timing of Transfusion Affect Bladder Cancer Mortality? European urology. 2014.
    1. Sadeghi N, Badalato GM, Hruby G, Kates M, McKiernan JM. The impact of perioperative blood transfusion on survival following radical cystectomy for urothelial carcinoma. The Canadian journal of urology. 2012;19(5):6443–9.
    1. Kaplan J, Sarnaik S, Gitlin J, Lusher J. Diminished helper/suppressor lymphocyte ratios and natural killer activity in recipients of repeated blood transfusions. Blood. 1984;64(1):308–10.
    1. Ghio M, Contini P, Mazzei C, Brenci S, Barberis G, Filaci G, et al. Soluble HLA class I, HLA class II, and Fas ligand in blood components: a possible key to explain the immunomodulatory effects of allogeneic blood transfusions. Blood. 1999;93(5):1770–7.
    1. Blumberg N, Heal JM. Effects of transfusion on immune function. Cancer recurrence and infection. Archives of pathology & laboratory medicine. 1994;118(4):371–9.
    1. Goodarzi M, Lee TH, Pallavicini M, Donegan E, Busch M. Unusual kinetics of white cell clearance in transfused mice. Transfusion. 1995;35(2):145–9.
    1. Blajchman M, Bordin J. The tumor growth-promoting effect of allogeneic blood transfusions. Immunological investigations. 1995;24(1–2):311–7.
    1. Fan S-T, Ng IO, Poon RT, Lo C-M, Liu C-L, Wong J. Hepatectomy for hepatocellular carcinoma: the surgeon's role in long-term survival. Archives of Surgery. 1999;134(10):1124–30.
    1. Law WL, Choi HK, Lee YM, Ho JW. The impact of postoperative complications on long-term outcomes following curative resection for colorectal cancer. Annals of surgical oncology. 2007;14(9):2559–66.
    1. Murthy B, Thomson C, Dodwell D, Shenoy H, Mikeljevic J, Forman D, et al. Postoperative wound complications and systemic recurrence in breast cancer. British journal of cancer. 2007;97(9):1211–7.
    1. Carson J, Spence R, Poses R, Bonavita G. Severity of anaemia and operative mortality and morbidity. The Lancet. 1988;331(8588):727–9.
    1. Katz SC, Shia J, Liau KH, Gonen M, Ruo L, Jarnagin WR, et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Annals of surgery. 2009;249(4):617–23. 10.1097/SLA.0b013e31819ed22f
    1. Vamvakas EC, Blajchman MA. Transfusion-related immunomodulation (TRIM): an update. Blood reviews. 2007;21(6):327–48.
    1. Vamvakas EC, Pineda AA. Autologous transfusion and other approaches to reduce allogeneic blood exposure. Bailliere's best practice & research Clinical haematology. 2000;13(4):533–47. Epub 2000/12/05. 10.1053/beha.2000.0098 .

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