肌肉浸润性膀胱癌新辅助化疗后接受根治性膀胱切除术的患者围手术期输血与较差的存活率有关

Tessa Ladner, Anna J. Black, Homayoun Zargar, Jonathan L. Wright, Andrew C. Thorpe, Todd M. Morgan, Jeffrey M. Holzbeierlein, M. S. Cookson, N. Jacobsen, A. Fairey, C. Dinney, M. Carmen Mir, Laura-Maria Krabbe, Jeffrey S. Montgomery, N. Vasdev, Evan Y. Yu, E. Xylinas, Andrew Stephenson, Jay B. Shah, S. Daneshmand, K. Zargar-Shoshtari, Philippe E. Spiess, Laura S. Mertens, B. V. van Rhijn, P. Grivas, W. Kassouf, M. Dall’Era, S. Sridhar, John S. McGrath, J. Aning, S. Shariat, T. Bivalacqua, Scott North, D. Barocas, Y. Lotan, Peter C. Black
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Methods: A retrospective analysis was performed on 949 patients with cT2-4aN0M0 bladder cancer who received NAC prior to RC between 2000 and 2013 at 19 centers. Kaplan–Meier estimates of overall survival (OS) were made. Presumed risk factors for OS were analyzed using Cox regression analysis. PBT was defined by the administration of any packed red blood cells during surgery or during the post-operative hospital stay. Results: A transfusion was given to 608 patients (64%). Transfused patients were more likely to have adverse clinical and pathologic parameters, including clinical stage and performance status. Transfused patients had worse OS (p = 0.01). On multivariable Cox regression, PBT was found to be independently associated with worse OS (HR 1.53 (95% CI 1.13–2.08), p = 0.007). Conclusions: PBT is common after NAC and RC, which may be linked, in part, to the anemia induced by NAC. 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引用次数: 0

摘要

目的:围手术期输血(PBT)与肌浸润性膀胱癌(MIBC)患者根治性膀胱切除术(RC)后生存率下降有关。在此,我们评估了新辅助化疗(NAC)前根治性膀胱切除术后输血与生存率之间的关系。方法我们对 2000 年至 2013 年间在 19 个中心接受新辅助化疗的 949 例 cT2-4aN0M0 膀胱癌患者进行了回顾性分析。对总生存期(OS)进行了卡普兰-梅耶估计。采用 Cox 回归分析法对 OS 的假定风险因素进行了分析。PBT的定义是在手术期间或术后住院期间使用任何包装红细胞。结果:608名患者(64%)接受了输血。输血患者更有可能出现不良的临床和病理参数,包括临床分期和表现状态。输血患者的 OS 较差(P = 0.01)。多变量 Cox 回归发现,PBT 与较差的 OS 独立相关(HR 1.53(95% CI 1.13-2.08),P = 0.007)。结论PBT在NAC和RC后很常见,这可能部分与NAC引起的贫血有关。PBT 与几个与 NAC 和 RC 后不良预后相关的不良风险因素有关,并且是多变量分析中不良 OS 的独立预测因素。进一步的研究应确定避免失血的措施是否能减少对 PBT 的需求,从而改善患者的预后。
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Perioperative Blood Transfusion Is Associated with Worse Survival in Patients Undergoing Radical Cystectomy after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer
Objectives: Perioperative blood transfusion (PBT) has been associated with worse survival after radical cystectomy (RC) in patients with muscle-invasive bladder cancer (MIBC). Here, we evaluated the association between PBT and survival after RC that was preceded by neoadjuvant chemotherapy (NAC). Methods: A retrospective analysis was performed on 949 patients with cT2-4aN0M0 bladder cancer who received NAC prior to RC between 2000 and 2013 at 19 centers. Kaplan–Meier estimates of overall survival (OS) were made. Presumed risk factors for OS were analyzed using Cox regression analysis. PBT was defined by the administration of any packed red blood cells during surgery or during the post-operative hospital stay. Results: A transfusion was given to 608 patients (64%). Transfused patients were more likely to have adverse clinical and pathologic parameters, including clinical stage and performance status. Transfused patients had worse OS (p = 0.01). On multivariable Cox regression, PBT was found to be independently associated with worse OS (HR 1.53 (95% CI 1.13–2.08), p = 0.007). Conclusions: PBT is common after NAC and RC, which may be linked, in part, to the anemia induced by NAC. PBT was associated with several adverse risk factors that correlate with poor outcomes after NAC and RC, and it was an independent predictor of adverse OS on multivariable analysis. Further study should determine if measures to avoid blood loss can reduce the need for PBT and thereby improve patient outcomes.
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