Research Article: Association between Allogeneic or Autologous Blood Transfusion and Survival in Patients after Radical Prostatectomy: A Systematic Review and Meta-Analysis

Date Published: January 30, 2017

Publisher: Public Library of Science

Author(s): Su-Liang Li, Yun Ye, Xiao-Hua Yuan, Senthilnathan Palaniyandi.

http://doi.org/10.1371/journal.pone.0171081

Abstract

A number of studies have investigated the effect of perioperative blood transfusion (PBT) for patients after radical prostatectomy (RP), with some reporting conflicting results. A systematic review of the literature and a meta-analysis were conducted to explore the association between PBT (autologous or allogeneic) and biochemical recurrence-free survival (BRFS), overall survival (OS) and cancer-specific survival (CSS) in patients undergoing RP.

The PubMed, Medline, Cochrane Library, and Embase databases were searched for published controlled clinical studies on perioperative allogeneic or autologous blood transfusion (BT) and patient survival after RP. STATA software version 12.0 was used for data analysis. We used hazard ratios (HRs) and 95% confidence intervals (CIs) to test the correlation between BT and patient survival after RP.

Data from a total of 26,698 patients in ten published studies were included in the meta-analysis. The meta-analysis results showed that autologous BT was not associated with BRFS (HR: 1.06; 95% CI: 0.96–1.18; Z = 1.17; P = 0.24), OS (HR: 0.86; 95% CI: 0.71–1.04; Z = 1.58; P = 0.11), or CSS (HR: 0.98; 95% CI: 0.49–1.96; Z = 0.05; P = 0.96). Allogeneic BT exhibited a significant association with worse BRFS (HR: 1.09; 95% CI: 1.01–1.16; Z = 2.37; P = 0.02), OS (HR: 1.43; 95% CI: 1.24–1.64; Z = 4.95; P<0.01) and CSS (HR: 1.74; 95% CI: 1.18–2.56; Z = 2.81; P = 0.005). Our data showed an association between allogeneic BT and reduced BRFS, OS and CSS in patients after RP. These findings indicate that perioperative blood conservation strategies are important for decreasing the allogeneic BT rate.

Partial Text

Prostate cancer (PCa) is a common malignant tumor of the male urogenital system, the second leading cause of cancer mortality in men worldwide and a significant cause of death in elderly men [1,2]. Radical prostatectomy (RP) is a standard treatment for clinically localized PCa [3,4]. Although many patients are disease free after surgery, many patients still continue to experience PCa recurrence. RP is associated with increased blood loss, which may lead to a need for either autologous or allogeneic transfusion [5]. Blood transfusion (BT) can be lifesaving in the perioperative period, but there are potential risks that can be attributed to transfusion-transmitted infection and transfusion-related immunomodulation (TRIM) [6].

By the end of 2016, a projected 180,890 new cases of PCa will have been diagnosed, and 26,120 men will have died of the disease in the United States alone. Mortality from PCa accounts for 8% of all cancer deaths worldwide [27]. RP is the main treatment for clinically localized PCa, which may lead to PBT, and the transfusion rate varies from 1.4–67.0%, depending on the surgical approach used [5]. Although BT is lifesaving and is safer than before, it still poses many significant risks, and the association between PBT and tumors’ clinical outcomes has been under debate over the past few years. Certain studies have demonstrated that BT is an independent risk factor for cancer progress and is associated with decreased survival and increased recurrence of cancer, including lung cancer [28], gastrointestinal cancer [7,29], bladder cancer [8,30], and breast cancer [31].

 

Source:

http://doi.org/10.1371/journal.pone.0171081