Blood transfusions may lead to worse outcomes after nephrectomy for RCC

A recent Israeli study concluded that perioperative blood transfusion (PBT) in patients after nephrectomy due to renal cell carcinoma (RCC) is associated with increased risk of tumor recurrence and mortality.¹ The findings were published in Urologic Oncology.

“Although these findings require further validation, continued efforts to minimize the use of blood products in patients with RCC are essential,” advised Yasmin Abu-Ghanem, MD, and colleagues.

Transfusion of red blood cells, platelets, and plasma has been long been standard therapeutic care in surgical and nonsurgical treatment of cancer patients. The benefits are clear, but increasing evidence shows that transfusing blood components may lead to negative clinical outcomes by affecting the immune defense as well as stimulating tumor growth, tethering, and dissemination.² A number of studies have evaluated the effects of PBT in oncology patients after cancer surgery.

In patients with lung, colorectal, and hepatocellular cancer, the studies demonstrated an increased risk of tumor recurrence and disease-specific mortality in patients who receive PBT. Based on these findings, surgeons are often hesitant to administer blood unless it is clearly indicated, although in some malignancies the correlation between blood transfusions and prognosis is unclear.

Studies examining the association between PBT and adverse outcomes in RCC have led to inconsistent results, which led Dr. Abu-Ghanem and co-authors to take a look at the incidence of PBT as well as the effect of PBT on survival in patients undergoing surgery for RCC.

The study retrospectively looked at patients with RCC who had a radical nephrectomy (RN) or partial nephrectomy (PN) between 1987 and 2013. Of the 1,159 patients, 198 (17.1%) received PBT, defined as a transfusion of red blood cells the day of surgery or during postoperative hospitalization. Five surgeons performed all of the surgeries, and administration of PBT was based on their discretion.

Statistical analysis was performed using univariate and multivariable logistic regression analyses to evaluate the association of PBT with cancer-specific survival (CSS), disease-free survival, and overall survival (OS).

The median follow-up after surgery was 63.2 months. During that time, 165 patients (14.2%) had disease recurrence (77 had local recurrence, 88 developed metastatic progression). Some of the risk factors for receiving PBT included low hemoglobin, larger renal mass, open surgical approach, and capsular invasion; there was no difference in tumor histology based on PBT status.

Those receiving a PBT had significantly increased risks of tumor recurrence, metastatic progression, death from RCC, and all-cause mortality, as well as worse 5-year cancer-specific survival (CSS) and overall survival (OS).

The researchers then looked at the subgroup of 582 patients who had PN to determine if the association between PBT and adverse prognosis remained significant. In general, RN-treated patients had significantly larger tumors and typically had more severe disease compared with PN counterparts, but no significant differences were noted with regard to the rate of blood transfusions between the groups (19.2% for RN, 14.9% for PN), and the results were similar to the total cohort.

After controlling for patient and tumor-related variables in the PN group, the association of PBT had an adverse effect on metastatic progression, CSS, and OS compared with patients who did not receive PBT. In both analyses, PBT was not associated with more aggressive disease or worse clinical features that are independent predictors of poor oncologic outcomes such as tumor stage, grade, or necrosis.

The authors noted that limitations of the study include the retrospective design, the lack of specific guidelines and indications for PBT, and possible changes in clinical management of RCC and blood administration over the years.

The researchers concluded that PBT was associated with worse outcomes in patients with RCC in both PN and RN including reduced recurrence-free survival, CSS, and OS. They advised that it is essential to minimize the use of blood products in patients with RCC after surgery.

 To read more about this study, click here.

References:

1. Abu-Ghanem Y, et al. Perioperative blood transfusion adversely affects prognosis after nephrectomy for renal cell carcinoma. Urologic Oncology. 2017; in press.

2. Goubran HA, et al. Impact of Transfusion on Cancer Growth and Outcome. Cancer Growth and Metastasis. 2016;9:1-8.