gms | German Medical Science

Purpose: Administration of red blood cells (RBC) is associated with worse cancer-related outomes in bladder cancer (BC) patients treated with cystectomy (RC). It can be hypothesized that coagulation dysfunction during RC may impair effective cancer cell elimination. We sought to investigate whether the adverse prognostic effects of intraoperative RBC administration are influenced by perioperative substitution of coagulation factors, i.e. fresh frozen plasma (FFP) or platelet concentrates (PC).

Methods: 329 patients were included. Intraoperative administration of RBC was defined as transfusion of allogeneic RBCs during the duration of RC. Recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS) rates were estimated using Kaplan-Meier method with log-rank testing. The median follow-up was 37 months (IQR: 10-55).

Results: Of the 329 patients, 197 (59.9%) received perioperative RBC, 59 (17.9%) FFP and 4 (1.2%) PC. Patients who received intraoperative RBC (N=118) were of female gender (<0.001) and higher age at RC (<0.001) and were also less likely to receive preoperative intravesical BCG therapy (p=0.009). In addition, they exhibited higher rates of intraoperative blood loss and transfused RBC units, lower preoperative hb levels and increased tumor sizes (all p<0.001). The rate of positive surgical margins (p=0.017) and preoperative serum CRP levels (p=0.047) were also significantly higher compared to patients without perioperative receipt of RBCs. Receipt of intraoperative RBC was associated with a lower 3-year RFS (55.1% vs. 63.5%; p=0.025), CSS (73.5% vs. 80.8%; p=0.051) and OS (51.3% vs. 71.3; p<0.001). Among patients with blood group A, receipt of intraoperative RBC was associated with significantly lower 5-year RFS (53.0 vs. 65.8%; p=0.033) whereas no significant association was found for patients with non-A blood group (p=0.58). Patients who received intraoperative RBC plus perioperative FFP (N=57) exhibited a significantly higher 3-year RFS compared to patients in which intraoperative RBC was administered only (N=69; 66.6% vs. 45.2%; p=0.041).

Conclusions: Intraoperative receipt of RBC exerts an adverse prognostic impact on survival. Perioperative administration of FFP seems to be associated with a reduced risk of recurrence in patients who need to receive intraoperative RBC. These findings suggest a prognostic benefit of perioperative correction of coagulation disorders which may occur as a sequela of intraoperative blood loss during RC.