Perioperative blood transfusion worsens kidney cancer patients’ survival

Feb 25 2014

By Sara Freeman, medwireNews Reporter

Patients who receive blood transfusions around the time of their surgery for nonmetastatic renal cell carcinoma (RCC) have a worse chance of survival than those who do not, results of a large US study suggest.

Receipt of a blood transfusion significantly reduced cancer-specific (68 vs 92%) and recurrence-free survival (63 vs 88%) at 5-years’ follow-up on univariate analysis. These differences were no longer significant after accounting for potential confounders, whereas a significant difference in overall survival (56 vs 82%) remained.

Indeed, patients who received a blood transfusion were 23% more likely to die of any cause than those who did not, after considering factors such as age, size and stage of tumour and performance status.

“While these results represent outcomes from a single tertiary care centre, and external validation is needed, continued efforts to limit the use of blood products in these patients are needed,” say researchers Stephen Boorjian and colleagues from the Mayo Clinic in Rochester, Minnesota.

Previous data have been from short-term studies or conflicting, so the Mayo Clinic team reviewed the medical records of 2318 patients with nonmetastatic RCC who had undergone partial or total nephrectomy at their institution between 1990 and 2006.

One-fifth (21%) of patients had received a perioperative blood transfusion (PBT), with a median of three units of blood transfused. The median follow-up was 9.1 years

The researchers found that patients receiving a PBT were significantly older at surgery, and more likely to be women, with more frequent symptomatic presentation. They were also more likely to have a worse performance status and adverse pathological features, such as locally advanced tumours, high nuclear grade and lymph node invasion. This group experienced higher median intraoperative blood loss during nephrectomy, at 878 mL versus 200 mL in those who did not receive a PBT.

“Among patients who received a PBT, an increasing number of units transfused was independently associated with increased all-cause mortality,” Boorjian and team report in BJU International. There was an 8% increase in the risk of death with every additional unit of blood transfused.

The study findings are limited by the nonrandomized, retrospective design, and multivariate analysis might not have adjusted completely for all the potential confounding factors, they caution.

Although confirmation of the findings is needed, the researchers conclude: “[W]e found that receipt of a PBT was associated with a significantly increased risk of all-cause mortality among patients undergoing nephrectomy for non-metastatic RCC.”

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