THE ROLE OF PERI-OPERATIVE BLOOD TRANSFUSION ON CANCER SPECIFIC AND OVERALL MORTALITY AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER

Only few studies investigated the impact of the peri-operative blood transfusion (PBT) rate on both cancerspecific (CSM) and overall mortality (OM) after radical cystectomy (RC) for bladder cancer (Bca). To date, no study has taken into account the possible prognostic role of the pre-operative hemoglobin level (Hb). The aim of this study was to evaluate the impact of both pre-operative Hb level and PBT rate on CSS and OS of patients who underwent RC. Materiali e metodi The study cohort included 1575 patients treated with RC for BCa between 1990 and 2012 at a single tertiary referral center. Complete clinical, pathological and follow up-data was available for all the patients. Kaplan- Meier curves were adopted to assess the CSM and OM rates in the comprehensive population. At univariable (UVA) and multivariable (MVA) Cox regression analyses the impact on CSS and OS of both PBT and Hb were initially analyzed separately. In a following step, PBT and Hb were simultaneously included in the same statistical model. Age at surgery, Hb, PBT, pathological T stage, pathological N stage were used as covariates. Risultati Mean age at RC was 67 years. A total of 580 (36.8%) patients received a PBT (mean number of blood units received: 3). Mean and median Hb values were 12.4 and 12.6 mg/dL (range 8.0-17.5 mg /dL), respectively. With a mean follow-up time of 41 months, CSS and OS were 83.1 vs. 75.2 and 68.3 vs. 59.8%, at 2 and 5 years, respectively. At UVA, patients who received PBT experienced a CSM (HR: 2.11; p Discussione The influence of immune system on bladder cancer is well known even if not completely understood. This influence can have several consequences. Firstly hematologic disorders, like alteration in hemoglobin levels, and systemic inflammation. Secondly, the immunomodulation could are caused also by PBT and sub sequentially has an immunosuppressive effect. Our study, based on a population of patients with BCa (n = 1575) treated with RC demonstrated the impact of PBT on CSS and OS. Despite this, no association was found at multivariable analysis consider. Conclusioni At multivariate statistical analysis, including both the PBT rate and the pre-operative Hb level, only the latter parameter was shown to be significantly correlated with CS and OM. Further studies are needed in order to investigate the suggested immunosuppressive effect of the PBT and the suspected influence of the pre-operative Hb level as a factor favoring the systemic dissemination of BC cells.