Urologic Oncology: Seminars and Original Investigations
Review articlePerioperative blood transfusion affects oncologic outcomes after nephrectomy for renal cell carcinoma: A systematic review and meta-analysis
Introduction
Renal cell carcinoma (RCC) is associated with approximately 84,400 new cases and leads to 34,700 deaths per year in the European Union countries alone [1]. Standard treatment for most RCC is surgical removal of the primary tumor [2]. Despite adequate surgery, 10% to 20% of patients with seemingly localized RCC treated with radical or partial nephrectomy experience local and/or distant recurrence [3,4]. RCC is a highly vascular disease with significant angiogenetic activity leading potentially higher blood loss compared to other diseases [5].
PBT has been associated with worse oncologic outcomes in several malignancies [6], [7], [8]. It has been hypothesized that PBT has an immunosuppressive effect, but the definitive mechanism underlying this association has not been uncovered yet [9]. In RCC, Soubra et al. reported, in a population-based study, that PBT was associated with overall mortality (OM) and cancer specific mortality (CSM) in 14,379 patients treated with nephrectomy [10]. Several other studies have provided further evidence on the prognostic value of PBT on RCC outcomes after nephrectomy [11], [12], [13], [14], [15], [16], [17], [18], [19], [20]. However, all studies suffer from common limitations such as single center design, small sample size, short follow-up and lack of data regarding confounding factors. No study to date had a prospective controlled design to allow for robust evidence to change clinical practice. We hypothesized that PBT might impact prognosis in patients with RCC after surgical treatment. To elucidate this, we conducted a systematic review and meta-analysis of the literature to survey the association of PBT with oncologic outcomes such as OM, CSM and disease recurrence in patients who had undergone surgical treatment for RCC.
Section snippets
Materials and methods
A completed PRISMA-P 2015 checklist is shown in the Supplementary table 1 to describe the methodology of our study clearly. The protocol has also been registered in the International Prospective Register of Systematic Reviews database (PROSPERO: CRD42018096910).
Study selection and characteristics
Our initial search identified 679 records. After removal of duplicates, 450 remained (Fig. 1). After screening the titles and abstracts, 388 articles were excluded. Then, we assessed full texts for selection leaving 7 studies for the qualitative and quantitative evidence synthesis including 19,681 patients.
The baseline characteristics of the 7 studies are outlined in Table 1. All included studies had a retrospective design and were published between 1994 and 2018 with 3 being from Europe, 3
Discussion
We investigate the association of PBT with oncologic outcomes in RCC patients treated with radical or partial nephrectomy. To the best of our knowledge, our study is the first systematic review and meta-analysis evaluating the association of PBT with oncologic outcomes. We relied on data from 7 published studies with a combined patient population of more than 19,000 patients. PBT was associated with significantly increased risks of OM, CSM and disease recurrence when all RCC patients treated
Conclusions
This systematic review and meta-analysis shows that PBT is significantly associated with OM, CSM and disease recurrence in patients treated with partial or radical nephrectomy for RCC. In nonmetastatic RCC patients, PBT is significantly associated with OM, but not anymore with cancer specific survival outcomes. However, current data is low quality and there is significant heterogeneity among included studies. Therefore, our findings should be validated in prospective cohorts.
Conflict of interest
No conflict of interest disclosures from any authors.
Author Contributions
Project development: T Iwata, S Kimura, PI Karakiewicz, F Preisser, Y Nasu, SF Shariat
Data collection: T Iwata, S Kimura, B Foerster
Data analysis: T Iwata, S Kimura, B Foerster, M Abufaraj
Manuscript writing/editing: T Iwata, S Kimura, B Foerster, M Abufaraj, PI Karakiewicz, F Preisser, Y Nasu, SF Shariat.
References (39)
- et al.
Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012
Eur J Cancer
(2013) - et al.
EAU guidelines on renal cell carcinoma: 2014 update
Eur Urol
(2015) - et al.
The impact of perioperative blood transfusion on cancer recurrence and survival following radical cystectomy
Eur Urol
(2013) - et al.
Transfusion-related immunomodulation (TRIM): an update
Blood Rev
(2007) - et al.
Effect of perioperative blood transfusion on mortality for major urologic malignancies
Clin Genitourin Cancer
(2015) - et al.
Random-effects model for meta-analysis of clinical trials: an update
Contemp Clin Trials
(2007) - et al.
Meta-analysis in clinical trials
Controlled Clin Trials
(1986) - et al.
Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions
Br J Anaesth
(2013) - et al.
Prognostic factors and predictive models in renal cell carcinoma: a contemporary review
Eur Urol
(2011) - et al.
External validation and comparison with other models of the International Metastatic Renal-Cell Carcinoma Database Consortium prognostic model: a population-based study
Lancet Oncol
(2013)
Predictors of cancer-specific survival after disease recurrence in patients with renal cell carcinoma: the effect of time to recurrence
Clin Genitourin Cancer
Renal cell carcinoma recurrence after nephrectomy for localized disease: predicting survival from time of recurrence
J Clin Oncol
First Prize (tie): hemorrhage following percutaneous renal surgery: characterization of angiographic findings
J Endourol
Perioperative factors affecting long-term outcomes of 473 consecutive patients undergoing hepatectomy for hepatocellular carcinoma
Ann Surg Oncol
Perioperative blood transfusions for the recurrence of colorectal cancer
Cochrane Database Syst Rev
Perioperative blood transfusion adversely affects prognosis after nephrectomy for renal cell carcinoma
Urol Oncol
Survival outcomes after radical and partial nephrectomy for clinical T2 renal tumours categorised by RENAL nephrometry score
BJU Int
The impact of perioperative blood transfusion on survival after nephrectomy for non-metastatic renal cell carcinoma (RCC)
BJU Int
Association between perioperative blood transfusion and oncologic outcomes after curative surgery for renal cell carcinoma
J Cancer
Cited by (11)
Surgical Management of Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus
2023, Urologic Clinics of North AmericaPrognostic value of perioperative red blood cell transfusion and anemia on survival and recurrence in oral squamous cell carcinoma
2020, Oral OncologyCitation Excerpt :This immunosuppressive effect, also called transfusion-related immunomodulation (TRIM), has been investigated extensively and can nowadays be characterized as an orchestra of residual leukocytes, apoptotic cells, cytokines and extracellular particles [9]. Even though a lot of effort has been invested to purify and improve RBTs, for example by establishing leukodepletion [10], numerous authors revealed a deleterious effect of RBTs in terms of survival and tumor control in a broad range of malignancies [11,12]. Interestingly there are a number of studies, attributing no or at least no profound negative effect to the outcome of malignancies after RBT [13].
Incidence and predictors of hypophosphataemia after ferric carboxymaltose use—A 3-year experience from a single institution in Singapore
2023, British Journal of HaematologyThe effects of perioperative transfusion of allogenic blood products of cancer recurrence
2021, Essentials of Blood Product Management in Anesthesia Practice
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
- 1
Takehiro Iwata and Shoji Kimura contributed equally to this project.