Perioperative Blood Transfusion as a Significant Predictor of Biochemical Recurrence and Survival after Radical Prostatectomy in Patients with Prostate Cancer
May
Perioperative Blood Transfusion as a Significant Predictor of Biochemical Recurrence and Survival after Radical Prostatectomy in Patients with Prostate Cancer
Jung Kwon Kim 0 1
Hyung Suk Kim 0 1
Juhyun Park 0 1
Chang Wook Jeong 0 1
Ja Hyeon Ku 0 1
Hyun Hoe Kim 0 1
Cheol Kwak 0 1
0 Department of Urology, Seoul National University Hospital , Seoul , Korea
1 Editor: Senthilnathan Palaniyandi, University of Kentucky , UNITED STATES
There have been conflicting reports regarding the association of perioperative blood transfusion (PBT) with oncologic outcomes including recurrence rates and survival outcomes in prostate cancer. We aimed to evaluate whether perioperative blood transfusion (PBT) affects biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS) following radical prostatectomy (RP) for patients with prostate cancer. A total of 2,713 patients who underwent RP for clinically localized prostate cancer between 1993 and 2014 were retrospectively analyzed. We performed a comparative analysis based on receipt of transfusion (PBT group vs. no-PBT group) and transfusion type (autologous PBT vs. allogeneic PBT). Univariate and multivariate Cox-proportional hazard regression analysis were performed to evaluate variables associated with BRFS, CSS, and OS. The Kaplan-Meier method was used to calculate survival estimates for BRFS, CSS, and OS, and log-rank test was used to conduct comparisons between the groups.
-
Data Availability Statement: All relevant data are
within the paper and its Supporting Information files.
Funding: The authors have no support or funding to
report.
Competing Interests: The authors have declared
that no competing interests exist.
Purpose
Results
The number of patients who received PBT was 440 (16.5%). Among these patients, 350
(79.5%) received allogeneic transfusion and the other 90 (20.5%) received autologous
transfusion. In a multivariate analysis, allogeneic PBT was found to be statistically
significant predictors of BRFS, CSS, and OS; conversely, autologous PBT was not. The
Kaplan
Meier survival analysis showed significantly decreased 5-year BRFS (79.2% vs. 70.1%, log-rank, p = 0.001), CSS (98.5% vs. 96.7%, log-rank, p = 0.012), and OS (95.5% vs. 90.6%, log-rank, p < 0.001) in the allogeneic PBT group compared to the no-allogeneic PBT
group. In the autologous PBT group, however, none of these were statistically significant
compared to the no-autologous PBT group.
Conclusions
We found that allogeneic PBT was significantly associated with decreased BRFS, CSS, and OS. This provides further support for the immunomodulation hypothesis for allogeneic PBT.
Introduction
Transfusion-related immunomodulation (TRIM), including alloimmunization, tolerance, and
immunosuppression [
1
], has been postulated to explain the association between perioperative
blood transfusion (PBT) and survival in a number of malignancies, including colon,
esophageal, and hepatic carcinomas [
2–4
]. However, it is difficult to conclude whether these
oncologic outcomes are secondary to PBT itself or whether PBT serves as a surrogate marker for
clinically important variables that may affect oncologic prognosis. Previous study suggested the
several reasons–including obscuring the operative field, limiting anatomical visualization, and
preventing full excision the tumor–to hypotheses for why an excessive blood loss followed by
PBT might be correlated with the oncologic outcomes [
5
].
In urological cancers, there have been conflicting reports regarding the association of PBT
with oncologic outcomes including recurrence rates and survival outcomes [
6–14
]. Specifically
for radical prostatectomy (RP), to the best of our knowledge, there have been over 10
retrospective studies that examining the association between PBT and recurrence and/or survival after
RP for prostate cancer [
7–9, 15–23
]. About one third of the studies suggested that PBT resulted
in increased cancer recurrence and/or mortality [
9, 20, 21, 23
], while the others showed no
significant associations [
7, 8, 15–19, 22
].
In the current study, we investigated whether PBT (autologous vs. allogeneic) affects
biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS) and overall survival
(OS) after RP in patients with prostate cancer, by using a large tertiary referral center RP
database.
Materials and Methods
Ethics Statement
The Institutional Review Boards (IRBs) of the Seoul National University Hospital approved
this study (Approval number: H-1510-049-710). As the present study was carried out
retrospectively, written informed consent from patients was waived by the IRBs. Personal identifiers
were completely removed and the data were analyzed anonymously. Our study was conducted
according to the ethical standards laid down in the 1964 Declaration of Helsinki and its later
amendments.
Study cohort
A total of 2,713 patients who underwent RP (open or laparoscopi (...truncated)