Effect of transfused donor and autoerythrocytes on the oncological outcomes of surgical treatment in patients with renal cell carcinoma with tumor-related venous thrombosis: observational study

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Background. The only effective treatment for renal cell carcinoma with tumor inferior vena cava (IVC) thrombosis is surgery. Nephrectomy with thrombectomy (NETE) is usually associated with clinically significant blood loss. The role of blood-sparing methods using autoerythrocyte reinfusion device (ARD) or replacement of blood loss with donor erythrocytes (DE) on the outcomes of NETE has not been well studied.

Aim. To study the rate of hemostasis disorders with intraoperative ARD use, as well as the effect of ARD and DE transfusions on specific (SS), relapse-free (RFS), and progression-free (PFS) survival of patients with renal cell carcinoma (RCC) after NETE.

Materials and methods. The observational study included medical data of 507 patients with RCC and tumor IVC thrombosis operated after NETE. The median volume of blood loss was 4000 [2000–6500] mL. In 312 (61.5%) patients, ARD without a leukocyte filter was used to compensate for blood loss (median volume of reinfused autoerythrocytes – AE was 1140 [700; 1900] mL). Transfusion of DE was required in 387 (76.3%) cases; the median number of DE transfused doses was 3 [1; 5]; 475 (93.7%) patients were discharged from the hospital. The median follow-up of all surviving patients was 24 (1–189) months.

Results. Indications for blood transfusions (DE and AE) were directly correlated to the pN (r=0.101; p=0.024) and pT (r=0.091; p=0.040) categories, respectively. The use of AE had no significant effect on the rate of hemostasis disorders and coagulopathic complications compared to other methods of blood loss replacement: 6.8% (21/311) vs 4.7% (9/193), p=0.227; 5.1% (16/311) vs 4.1% (8/193), p=0.394, respectively. ARD had no effect on SS, RFS (after radical surgery), and PFS (after cytoreductive surgery) after NETE. There was a reduction of SS in patients who received DE transfusions compared with those who did not (hazard ratio 0.4; 95% confidence interval 0.1–0.9; p=0.048). The effects of DE transfusions on RFS and PFS were not identified.

Conclusion. Intraoperative ARD use is an effective and safe method of correcting anemia, which does not increase the risk of coagulopathic complications or decrease survival rates. The non-use of the leukocyte filter during AE preparation does not worsen the medium-term oncological results of RCC surgical treatment with tumor IVC thrombosis. The effect of DE transfusion on the survival of RCC patients after NETE requires further research.

作者简介

Maria Volkova

Russian Medical Academy of Continuous Professional Education; City Clinical Oncology Hospital №1

编辑信件的主要联系方式.
Email: mivolkova6@gmail.com
ORCID iD: 0000-0001-7754-6624

D. Sci. (Med.), Russian Medical Academy of Continuous Professional Education, City Clinical Oncology Hospital №1

俄罗斯联邦, Moscow; Moscow

Pavel Feoktistov

Blokhin National Medical Research Center of Oncology

Email: mivolkova6@gmail.com
ORCID iD: 0000-0001-6024-5817

Cand. Sci. (Med.), Blokhin National Medical Research Center of Oncology

俄罗斯联邦, Moscow

Adilet Begaliev

City Clinical Oncology Hospital №1

Email: mivolkova6@gmail.com
ORCID iD: 0000-0002-0755-7421

Cand. Sci. (Med.), City Clinical Oncology Hospital №1

俄罗斯联邦, Moscow

Alexandr Shin

Blokhin National Medical Research Center of Oncology

Email: mivolkova6@gmail.com
ORCID iD: 0000-0002-3595-3472

Cand. Sci. (Med.), Blokhin National Medical Research Center of Oncology

俄罗斯联邦, Moscow

Vsevolod Matveev

Blokhin National Medical Research Center of Oncology

Email: mivolkova6@gmail.com
ORCID iD: 0000-0001-7748-9527

D. Sci. (Med.), Prof., Corr. Memb. RAS, Blokhin National Medical Research Center of Oncology

俄罗斯联邦, Moscow

Aleksey Prikhodchenko

Scientific and Educational Center “Eurasian Cancer Program EAFO”

Email: mivolkova6@gmail.com
ORCID iD: 0000-0002-4770-0034

Cand. Sci. (Med.), Scientific and Educational Center “Eurasian Cancer Program EAFO”

俄罗斯联邦, Moscow

参考

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2. Fig. 1. Specific survival (SS) of patients with renal cell carcinoma with tumor inferior vena cava (IVC) thrombosis after nephrectomy and thrombectomy, depending on the autoerythrocyte reinfusion device use.

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3. Fig. 2. SS of patients with renal cell carcinoma with tumor IVC thrombosis after nephrectomy and thrombectomy, depending on the donor erythrocytes transfusion.

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