Impact of Packed Red Blood Cells and Fresh Frozen Plasma Given During Radical Cystectomy and Urinary Diversion on Cancer-related Outcome and Survival: An Observational Cohort Study

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“…Transfusion-associated bacterial contamination and viral infections have been reported. The incidence of cancer receding and an increase in mortality have been reported for bladder, colon, and gastric cancer (Sun et al, 2015;Velásquez and Cata, 2015;Amri et al, 2017;Furrer et al, 2018), and rare-but still occurring-mistransfusions may lead to severe problems.…”

Reply to Mark C. Kendall’s Letter to the Editor re: Marc A. Furrer, Adrian Fellmann, Marc P. Schneider, George N. Thalmann, Fiona C. Burkhard, Patrick Y. Wuethrich. Impact of Packed Red Blood Cells and Fresh Frozen Plasma Given During Radical Cystectomy and Urinary Diversion on Cancer-related Outcome and Survival: An Observational Cohort Study. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2017.09.010

“…Kendall's final concern was the missing report of an analysis of interaction and discrimination/calibration of the model. As stated for Tables 3 and 4 [1], the final multivariate Cox proportional hazards regression analyses could not detect any significant interactions between the variables included and significant residual tests be not be found, including the proportional hazards assumption for a Cox regression model fit. In addition, we used a low p value (<0.05) for the drop-out criterion in multivariate Cox proportional hazards regression analyses.…”

“…We thank Dr. Kendall for his valuable comments. We acknowledge, as stated in our article, that our study has some limitations owing to the retrospective design [1]. Dr. Kendall's first concern is compliance with our internal recommendation for the administration of packed red blood cells (PRBCs) of <80 g/l or <100 g/l in the case of coronary artery disease.…”

“…In our study, we did find more advanced disease in the group receiving blood transfusion. We did specifically analyse outcomes for patients receiving blood transfusion (Table 4 [1]) and a sensitivity analysis then showed that the administration of PRBC but not FFP products was associated with poorer outcomes. Whether additional supportive use of a propensity score analysis could increase accuracy within a cohort that included a high number of cases and events is a matter for discussion [10].…”

Re: Marc A. Furrer, Adrian Fellmann, Marc P. Schneider, George N. Thalmann, Fiona C. Burkhard, Patrick Y. Wuethrich. Impact of Packed Red Blood Cells and Fresh Frozen Plasma Given During Radical Cystectomy and Urinary Diversion on Cancer-related Outcome and Survival: An Observational Cohort Study. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2017.09.010

“…I read with great interest the article by Furrer et al [1]. The authors performed a retrospective study of 885 patients with bladder cancer who underwent radical cystectomy and concluded that administration of packed red blood cells (PRBCs) and fresh frozen plasma was associated with significantly inferior cancer-specific and overall survival.…”