Timing of blood transfusion and not ABO blood type is associated with survival in patients treated with radical cystectomy for nonmetastatic bladder cancer

Results from a single high-volume institution

Marco Moschini, Marco Bianchi, Martina Sofia Rossi, Paolo Dell'Oglio, Giorgio Gandaglia, Nicola Fossati, Agostino Mattei, Rocco Damiano, Shahrokh F. Shariat, Andrea Salonia, Francesco Montorsi, Alberto Briganti, Renzo Colombo, Andrea Gallina

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Introduction and objectives: Perioperative transfusions have been recently associated to poor outcomes as an indirect consequence of immune-hematological changes related to transfusion itself and blood type. We tested the role of blood transfusion on cancer-specific mortality (CSM) and overall mortality (OM), considering the effect of ABO system, Rh factor, and timing of transfusions. Materials and methods: The study focused on 728 patients with bladder cancer treated with radical cystectomy at a single tertiary care referral center between January 1995 and August 2013 with complete ABO blood type information. Kaplan-Meier analysis was used to assess the effect of transfusions, stratified according to ABO type and Rh factor, on CSM and OM. The same endpoints were tested in Cox regression models, after adjusting for all available confounders. Results: A total of 341 (46.8%), 277 (38.0%), 83 (11.4%), and 27 (3.7%) patients had blood type O, A, B and AB, respectively. Overall, 630 (86.5%) and 98 (13.5%) patients were Rh-and Rh+, respectively. At a median follow-up time of 65 months, 225 (30.9%) and 282 (38.7%) patients recorded CSM and OM, respectively. At univariable analyses, ABO blood type and Rh status were not associated to either CSM or OM (all P>0.2). Similar results were observed when ABO blood type and Rh factor were tested in multivariable models (all P>0.3). Conversely, Charlson score, preoperative hemoglobin, number of nodes removed, pathological T stage, and number of positive nodes were associated to both CSM and OM (all P0.05) was associated with an increase of CSM and OM. Conclusions: Although ABO type or Rh factor or both were associated with several adverse outcomes in many cancers, we were not able to confirm this association in bladder cancer. Based on our results, the effect of transfusion on survival is independent by ABO type but is associated to the timing of blood supply administration.

Original languageEnglish
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
Publication statusAccepted/In press - Nov 16 2015

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Cystectomy
Urinary Bladder Neoplasms
Blood Transfusion
Survival
Mortality
Rh-Hr Blood-Group System
ABO Blood-Group System
Neoplasms
Tertiary Care Centers
Kaplan-Meier Estimate
Proportional Hazards Models
Hemoglobins

Keywords

  • ABO type
  • Bladder cancer
  • Blood type
  • Intraoperative transfusion
  • Radical cystectomy
  • Transfusion

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Timing of blood transfusion and not ABO blood type is associated with survival in patients treated with radical cystectomy for nonmetastatic bladder cancer : Results from a single high-volume institution. / Moschini, Marco; Bianchi, Marco; Rossi, Martina Sofia; Dell'Oglio, Paolo; Gandaglia, Giorgio; Fossati, Nicola; Mattei, Agostino; Damiano, Rocco; Shariat, Shahrokh F.; Salonia, Andrea; Montorsi, Francesco; Briganti, Alberto; Colombo, Renzo; Gallina, Andrea.

In: Urologic Oncology: Seminars and Original Investigations, 16.11.2015.

Research output: Contribution to journalArticle

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abstract = "Introduction and objectives: Perioperative transfusions have been recently associated to poor outcomes as an indirect consequence of immune-hematological changes related to transfusion itself and blood type. We tested the role of blood transfusion on cancer-specific mortality (CSM) and overall mortality (OM), considering the effect of ABO system, Rh factor, and timing of transfusions. Materials and methods: The study focused on 728 patients with bladder cancer treated with radical cystectomy at a single tertiary care referral center between January 1995 and August 2013 with complete ABO blood type information. Kaplan-Meier analysis was used to assess the effect of transfusions, stratified according to ABO type and Rh factor, on CSM and OM. The same endpoints were tested in Cox regression models, after adjusting for all available confounders. Results: A total of 341 (46.8{\%}), 277 (38.0{\%}), 83 (11.4{\%}), and 27 (3.7{\%}) patients had blood type O, A, B and AB, respectively. Overall, 630 (86.5{\%}) and 98 (13.5{\%}) patients were Rh-and Rh+, respectively. At a median follow-up time of 65 months, 225 (30.9{\%}) and 282 (38.7{\%}) patients recorded CSM and OM, respectively. At univariable analyses, ABO blood type and Rh status were not associated to either CSM or OM (all P>0.2). Similar results were observed when ABO blood type and Rh factor were tested in multivariable models (all P>0.3). Conversely, Charlson score, preoperative hemoglobin, number of nodes removed, pathological T stage, and number of positive nodes were associated to both CSM and OM (all P0.05) was associated with an increase of CSM and OM. Conclusions: Although ABO type or Rh factor or both were associated with several adverse outcomes in many cancers, we were not able to confirm this association in bladder cancer. Based on our results, the effect of transfusion on survival is independent by ABO type but is associated to the timing of blood supply administration.",
keywords = "ABO type, Bladder cancer, Blood type, Intraoperative transfusion, Radical cystectomy, Transfusion",
author = "Marco Moschini and Marco Bianchi and Rossi, {Martina Sofia} and Paolo Dell'Oglio and Giorgio Gandaglia and Nicola Fossati and Agostino Mattei and Rocco Damiano and Shariat, {Shahrokh F.} and Andrea Salonia and Francesco Montorsi and Alberto Briganti and Renzo Colombo and Andrea Gallina",
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T1 - Timing of blood transfusion and not ABO blood type is associated with survival in patients treated with radical cystectomy for nonmetastatic bladder cancer

T2 - Results from a single high-volume institution

AU - Moschini, Marco

AU - Bianchi, Marco

AU - Rossi, Martina Sofia

AU - Dell'Oglio, Paolo

AU - Gandaglia, Giorgio

AU - Fossati, Nicola

AU - Mattei, Agostino

AU - Damiano, Rocco

AU - Shariat, Shahrokh F.

AU - Salonia, Andrea

AU - Montorsi, Francesco

AU - Briganti, Alberto

AU - Colombo, Renzo

AU - Gallina, Andrea

PY - 2015/11/16

Y1 - 2015/11/16

N2 - Introduction and objectives: Perioperative transfusions have been recently associated to poor outcomes as an indirect consequence of immune-hematological changes related to transfusion itself and blood type. We tested the role of blood transfusion on cancer-specific mortality (CSM) and overall mortality (OM), considering the effect of ABO system, Rh factor, and timing of transfusions. Materials and methods: The study focused on 728 patients with bladder cancer treated with radical cystectomy at a single tertiary care referral center between January 1995 and August 2013 with complete ABO blood type information. Kaplan-Meier analysis was used to assess the effect of transfusions, stratified according to ABO type and Rh factor, on CSM and OM. The same endpoints were tested in Cox regression models, after adjusting for all available confounders. Results: A total of 341 (46.8%), 277 (38.0%), 83 (11.4%), and 27 (3.7%) patients had blood type O, A, B and AB, respectively. Overall, 630 (86.5%) and 98 (13.5%) patients were Rh-and Rh+, respectively. At a median follow-up time of 65 months, 225 (30.9%) and 282 (38.7%) patients recorded CSM and OM, respectively. At univariable analyses, ABO blood type and Rh status were not associated to either CSM or OM (all P>0.2). Similar results were observed when ABO blood type and Rh factor were tested in multivariable models (all P>0.3). Conversely, Charlson score, preoperative hemoglobin, number of nodes removed, pathological T stage, and number of positive nodes were associated to both CSM and OM (all P0.05) was associated with an increase of CSM and OM. Conclusions: Although ABO type or Rh factor or both were associated with several adverse outcomes in many cancers, we were not able to confirm this association in bladder cancer. Based on our results, the effect of transfusion on survival is independent by ABO type but is associated to the timing of blood supply administration.

AB - Introduction and objectives: Perioperative transfusions have been recently associated to poor outcomes as an indirect consequence of immune-hematological changes related to transfusion itself and blood type. We tested the role of blood transfusion on cancer-specific mortality (CSM) and overall mortality (OM), considering the effect of ABO system, Rh factor, and timing of transfusions. Materials and methods: The study focused on 728 patients with bladder cancer treated with radical cystectomy at a single tertiary care referral center between January 1995 and August 2013 with complete ABO blood type information. Kaplan-Meier analysis was used to assess the effect of transfusions, stratified according to ABO type and Rh factor, on CSM and OM. The same endpoints were tested in Cox regression models, after adjusting for all available confounders. Results: A total of 341 (46.8%), 277 (38.0%), 83 (11.4%), and 27 (3.7%) patients had blood type O, A, B and AB, respectively. Overall, 630 (86.5%) and 98 (13.5%) patients were Rh-and Rh+, respectively. At a median follow-up time of 65 months, 225 (30.9%) and 282 (38.7%) patients recorded CSM and OM, respectively. At univariable analyses, ABO blood type and Rh status were not associated to either CSM or OM (all P>0.2). Similar results were observed when ABO blood type and Rh factor were tested in multivariable models (all P>0.3). Conversely, Charlson score, preoperative hemoglobin, number of nodes removed, pathological T stage, and number of positive nodes were associated to both CSM and OM (all P0.05) was associated with an increase of CSM and OM. Conclusions: Although ABO type or Rh factor or both were associated with several adverse outcomes in many cancers, we were not able to confirm this association in bladder cancer. Based on our results, the effect of transfusion on survival is independent by ABO type but is associated to the timing of blood supply administration.

KW - ABO type

KW - Bladder cancer

KW - Blood type

KW - Intraoperative transfusion

KW - Radical cystectomy

KW - Transfusion

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