Association between perioperative blood transfusion and survival outcomes after radical cystectomy for bladder cancer

Perioperative blood transfusion (BT) has been suggested as a potential prognostic factor in patients undergoing radical cystectomy (RC) for bladder cancer, although its impact remains controversial. We aimed to evaluate the association between perioperative BT and short- and long-term outcomes in a contemporary single-center RC series.

We retrospectively analyzed consecutive patients who underwent RC for bladder cancer at our institution between 2017 and 2024. Demographic, perioperative, and pathological variables were collected. Outcomes included 30-day mortality, overall survival (OS), and cancer-specific survival (CSS). Survival analyses were performed using Kaplan-Meier estimates and compared with the log-rank test. Multivariable Cox and logistic regression models were constructed to adjust for potential confounders.

A total of 200 patients were included (median age 69 years [31-88]), of whom 105 (52.5%) received perioperative blood transfusion (BT). Median estimated blood loss was 700 mL (100-3500). Thirty-day mortality was 6% (12 patients). Overall survival (OS) was 63.5% (127 patients), and cancer-specific survival (CSS) was 72.5% (145 patients) at the end of follow-up. Perioperative BT was significantly associated with worse overall survival (HR 3.28, 95% CI 1.88-5.72, p < 0.001), cancer-specific survival (HR 5.33, 95% CI 2.55-11.13, p < 0.001), and increased 30-day postoperative mortality (OR 10.88, 95% CI 1.38-85.6, p = 0.024). In multivariable analyses, perioperative BT remained independently associated with worse OS and CSS, together with advanced pathological T stage, positive nodal status, and higher ASA score, but was not independently associated with 30-day mortality.

Perioperative blood transfusion was associated with worse overall and cancer-specific survival after radical cystectomy, but not with early postoperative mortality after adjustment. These findings should be interpreted as an association rather than a causal relationship, as residual confounding cannot be excluded. Strategies aimed at optimizing preoperative anaemia and reducing transfusion requirements may contribute to improving perioperative management in patients undergoing radical cystectomy.