Perioperative Blood Transfusion as a Significant Predictor of Biochemical Recurrence and Survival after Radical Prostatectomy in Patients with Prostate Cancer

PLOS ONE, Dec 2019

Purpose 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. Materials and Methods 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. 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.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0154918&type=printable

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)


This is a preview of a remote PDF: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0154918&type=printable

Jung Kwon Kim, Hyung Suk Kim, Juhyun Park, Chang Wook Jeong, Ja Hyeon Ku, Hyun Hoe Kim, Cheol Kwak. Perioperative Blood Transfusion as a Significant Predictor of Biochemical Recurrence and Survival after Radical Prostatectomy in Patients with Prostate Cancer, PLOS ONE, 2016, Volume 11, Issue 5, DOI: 10.1371/journal.pone.0154918