Blood storage duration and biochemical recurrence of cancer after radical prostatectomy

Abstract

Objective: To test the hypothesis that perioperative transfusion of allogeneic and autologous red blood cells (RBCs) stored for a prolonged period speeds biochemical recurrence of prostate cancer after prostatectomy.

Patients and methods: We evaluated biochemical prostate cancer recurrence in men who had undergone radical prostatectomy and perioperative blood transfusions from July 6, 1998, through December 27, 2007. Those who received allogeneic blood transfusions were assigned to nonoverlapping "younger," "middle," and "older" RBC storage duration groups. Those who received autologous RBC transfusions were analyzed using the maximum storage duration as the primary exposure. We evaluated the association between RBC storage duration and biochemical recurrence using multivariable Cox proportional hazards regression.

Results: A total of 405 patients received allogeneic transfusions. At 5 years, the biochemical recurrence-free survival rate was 74%, 71%, and 76% for patients who received younger, middle, and older RBCs, respectively; our Cox model indicated no significant differences in biochemical recurrence rates between the groups (P=.82; Wald test). Among patients who received autologous transfusions (n=350), maximum RBC age was not significantly associated with biochemical cancer recurrence (P=.95). At 5 years, the biochemical recurrence-free survival rate was 85% and 81% for patients who received younger and older than 21-day-old RBCs, respectively.

Conclusion: In patients undergoing radical prostatectomy who require RBC transfusion, recurrence risk does not appear to be independently associated with blood storage duration.

FIGURE 1.

Summary of patients included in the study. Asterisk indicates that these patients received a combination of “younger,” “middle,” and “older” allogeneic red blood cells (RBCs). PSA = prostate-specific antigen.

FIGURE 2.

Kaplan-Meier survival density function estimates comparing patients who received only allogeneic blood who were grouped according to red blood cell (RBC) storage duration exposure. Univariable survival estimates were not significantly different (P=.97, log-rank test); multivariate P=.29.

FIGURE 3.

Kaplan-Meier survival density function estimates comparing patients who received only autologous blood who were grouped according to patient-specific maximum red blood cell (RBC) storage duration. For Kaplan-Meier estimation purposes only, patients whose maximum RBC age was equal to or less than the median of 21 days were assigned to the “younger” group and patients whose maximum RBC age was greater than the median were assigned to the “older” group. Univariable survival estimates were not significantly different (P=.87, log-rank test); multivariable P=.14 (using maximum RBC age as a continuous predictor variable).