Blood transfusions during neoadjuvant chemotherapy for muscle-invasive urinary bladder cancer may have a negative impact on overall survival

Abstract

Objective: To evaluate the extent and plausible effects of blood transfusions given during cisplatin-based neoadjuvant chemotherapy (NAC) on overall survival in patients with muscle-invasive urothelial bladder cancer (MIBC) undergoing NAC and radical cystectomy (RC).

Background: Several studies have demonstrated a decreased survival for MIBC patients receiving allogenic peri- and postoperative blood transfusions in conjunction with RC. No studies have previously investigated the effects of blood transfusions during NAC.

Materials and methods: 120 patients with MIBC (cT2-T4aN0M0) undergoing NAC and RC between 2008 and 2014 at four Swedish cystectomy centers were retrospectively evaluated. Clinicopathological data were obtained, including data of allogenic blood administration. Survival data was analyzed by Kaplan–Meier plotting and Cox regression.

Results: One third of the cohort received blood transfusions during the period of NAC. In univariate analysis, blood transfusions during NAC, nodal stage and advanced tumor stage (pT >2) were negative prognostic factors for survival. In multivariate analysis, only pNx and pT >2 remained significant negative prognostic factors. In a subgroup analysis consisting of patients with localized tumors without dissemination (n = 96), patients that received transfusions during NAC showed an 18.5% absolute risk increase of death at five years of observation, although without statistical significance (p = .197).

Conclusions: This is the first time that the extent and plausible effects of allogenic blood transfusions during NAC is examined in MIBC. Data suggest that there may be an association between blood transfusion and poor pathological and oncological outcome. Firm conclusions are difficult to draw due to few study participants and the retrospective nature of the study.

Keywords:

• Urinary bladder cancer
• neoadjuvant therapies
• erythrocyte transfusions
• cystectomy
• survival analysis
• transfusion related immunomodulation

Acknowledgements

We would first of all, like to acknowledge the valuable assistance and cooperation of our dear colleague, Dr. Johan Hanson (Gävle County Hospital and Uppsala University), who passed away during the preparations of this mansucript. We would also like to thank Roger Brännström (Sunderbyn Hospital, Luleå), Martin Odmark (Sundsvall-Härnösand County hospital, Sundsvall), Annika Axelsson Åhs (Gävle County Hospital), Botan Hawas (Västmanland County Hospital), and Maud Nilsson (University Hospital of Umeå) for valuable assistance in the process of data collection. We also acknowledge the valuable assistance from statistician Marcus Thuresson at Statisticon AB, Uppsala, Sweden and the important comments from our colleague Dr. Michael Mints, MD, PhD, the Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval and consent to participate

The study was approved by the Regional Ethical Committee in Umeå (EPN-Umeå, dnr: 2015/395-32 and dnr: 2016/403-32 M). Informed consent was specifically not needed according to the regional ethical committee and was therefore not obtained.

Additional information

Funding

This work was supported by the Cancer Research Foundation in Northern Sweden [AMP 15-790] and by the Swedish Research Council funding for clinical research in medicine (ALF) in Västerbotten, VLL, Sweden [VLL-320191 and VLL-400891].