EXTENT OF BLOOD-TRANSFUSION AND CANCER-RELATED MORTALITY AFTER CYSTECTOMY AND URINARY-DIVERSION FOR BLADDER-CANCER

Objective To assess the possible adverse effect of perioperative blood transfusion on cancer-related survival after radical cystectomy for bladder cancer. Patients and methods The hospital records of 130 patients treated with cystectomy and urinary diversion for bladder cancer between 1967 and 1986 were retrospectively reviewed. Results Standard proportional hazards estimation revealed tumour stage and radiation response after pre-operative irradiation to be significantly associated with cancer-related mortality, whereas age, tumour grade or the extent of peri-operative blood transfusion were not. In models which allowed time varying effects a significantly changed effect of blood transfusion (greater than or equal to 7 versus less than or equal to 6 units) was observed, from an initially insignificantly increased relative hazard (RH) (RH = 1.44 at 6 months) to an insignificantly decreased effect after longer follow-up (RH = 0.53 after 2 years). Conclusion Although no overall association between blood transfusion and cancer-related mortality was found, a tendency towards an increased risk early in the follow-up period was observed if more than 6 units were transfused. However, these results need confirmation in further studies before a restrictive attitude towards peri-operative blood transfusion is recommended.