Timing of blood transfusion and oncologic outcomes in patients treated with radical nephroureterectomy for upper tract urothelial carcinoma
To evaluate the impact of timing of blood transfusion in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).
Outcomes of consecutive patients with UTUC treated with RNU were analyzed. Clinicopathologic factors were compared using Fisher’s exact test or the Wilcoxon rank-sum test between patients who received any transfusion and no transfusion, and between patients receiving intraoperative transfusion only and patients receiving no transfusion. Cancer-specific and overall survival were estimated and multivariable analyses were performed to assess the impact of timing of transfusion on clinical outcomes.
Among 402 patients included in this study, 71 (17.6%) patients received a transfusion at any point and 27 (6.7%) patients received an intraoperative blood transfusion. Transfusion at any time, patient comorbidity, high grade, advanced stage, positive surgical margins, low preoperative hemoglobin, longer operative duration, and increased blood loss were significantly associated with cancer-specific survival (DSS) on univariable analysis (HR 1.85, 95% CI 1.20–2.85, p < 0.005). In the multivariable analysis, transfusion at any point was not a prognostic factor (HR 1.00, 95% CI 0.60–1.68, p = 0.99). When examining intraoperatively transfusion only, transfusion was significantly associated with DSS (HR 1.91, 95% CI 1.01–3.59, p = 0.045) but no longer significant in multivariable analysis (HR 0.72, 95% CI 0.32–1.65, p = 0.440).
Our study indicates that the administration of blood transfusion either intraoperatively or postoperatively is not associated with clinical or oncological outcomes in patients with upper tract urothelial carcinoma when adjusted for other factors in multivariable analysis. Further study is required.
KeywordsTransfusion Intraoperative blood transfusion Surgery Urothelial carcinoma UTTCC
Upper tract urothelial carcinoma
American Society of Anesthesiologists
Estimated blood loss
AB: protocol/project development, manuscript writing/editing, data collection or management, data analysis. SK: data collection or management. AW: data collection or management. KM: data collection or management. MV: data collection or management. JZ: data analysis. IO: data analysis. BB: protocol/project development, manuscript writing/editing. GD: protocol/project development, manuscript writing/editing. EC: protocol/project development, manuscript writing/editing, data collection or management. JC: protocol/project development, manuscript writing/editing.
This work was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. This work as also supported in part by a Grant from the Urology Care Foundation Research Scholars Program and the Society for Urologic Oncology Research Scholar Fund. SDK received support from the Ruth L. Kirschstein National Research Service Award T32 CA082088.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest. Informed consent was waived due to retrospective, de-identified nature of manuscript. Institutional review board approval was obtained. No animals were used as a part of this study. No change in standard of care for human patients was done for this retrospective review.
- 3.Roupret M, Hupertan V, Seisen T, Colin P, Xylinas E, Yates DR et al (2013) Prediction of cancer specific survival after radical nephroureterectomy for upper tract urothelial carcinoma: development of an optimized postoperative nomogram using decision curve analysis. J Urol 189(5):1662–1669CrossRefPubMedGoogle Scholar
- 5.Krabbe LM, Westerman ME, Bagrodia A, Gayed BA, Khalil D, Kapur P et al (2014) Surgical management of the distal ureter during radical nephroureterectomy is an independent predictor of oncological outcomes: results of a current series and a review of the literature. Urol Oncol 32(1):54e19-26CrossRefGoogle Scholar