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Systematic Review and Meta-Analysis on the Role of Perioperative Blood Transfusion in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma

Kochergin M 1 , Fahmy O 2 , Esken L 3 , Goetze T 4 , Xylinas E 5 , Stief CG 6 Show all authors , Gakis G 7

Affiliations 

  • 1 Department of Urology and Neurourology, BG Unfallkrankenhaus Berlin, Berlin, Germany
  • 2 Department of Urology, Universiti Putra Malaysia (UPM), Selangor, Malaysia
  • 3 Department of Urology and Pediatric Urology, Nordwest Hospital, Frankfurt am Main, Germany
  • 4 Institute of Clinical Cancer Research, Nordwest Hospital, Frankfurt am Main, Germany
  • 5 Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
  • 6 Department of Urology, University Hospital Ludwig-Maximilians-University, Munich, Germany
  • 7 Department of Urology, University Hospital Würzburg, Würzburg, Germany
Bladder Cancer, 2022;8(3):315-327.
PMID: 38993684 DOI: 10.3233/BLC-201534

Abstract

BACKGROUND: Radical cystectomy (RC) is the standard of care in patients with muscle-invasive bladder cancer. The impact of perioperative red blood cell (RBC) transfusion on oncological outcomes after RC is not clearly established as the existing publications show conflicting results.

OBJECTIVES: The aim of this systematic review and meta-analysis was to investigate the prognostic role of perioperative RBC transfusion on oncological outcomes after RC.

METHODS: Systematic online search on PubMed was conducted, based on PRISMA criteria for publications reporting on RBC transfusion during RC. Publications with the following criteria were included: (I) reported data on perioperative blood transfusion; (II) Reported Hazard ratio (HR) and 95% -confidence interval (CI) for the impact of transfusion on survival outcomes. Primary outcome was the impact of perioperative RBC transfusion on recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Risk of bias assessment was performed using Newcastle-Ottawa Scale. Statistical analysis was performed using Revman 5.4 software.

RESULTS: From 27 primarily identified publications, 19 eligible articles including 22897 patients were selected. Perioperative RBC transfusion showed no impact on RFS (Z = 1.34; p = 0,18) and significant negative impact on CSS (Z = 2.67; p = 0.008) and OS (Z = 3.22; p = 0.001). Intraoperative RBC transfusion showed no impact on RFS (Z = 0.58; p = 0.56) and CSS (Z = 1.06; p = 0.29) and OS (Z = 1.47; p = 0.14).Postoperative RBC transfusion showed non-significant trend towards improved RFS (Z = 1.89; p = 0.06) and no impact on CSS (Z = 1.56; p = 0.12) and OS (Z = 0.53 p = 0.60).

CONCLUSION: In this meta-analysis, we found perioperative blood transfusion to be a significant predictor only for worse CSS and OS but not for RFS. This effect may be determined by differences in tumor stages and patient comorbidities for which this meta-analysis cannot control due to lack of respective raw data.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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