World Journal of Urology

, Volume 36, Issue 4, pp 645–653 | Cite as

Timing of blood transfusion and oncologic outcomes in patients treated with radical nephroureterectomy for upper tract urothelial carcinoma

  • Aditya Bagrodia
  • Samuel Kaffenberger
  • Andrew Winer
  • Katie Murray
  • Michael Vacchio
  • Junting Zheng
  • Irina Ostrovnaya
  • Bernard H. Bochner
  • Guido Dalbagni
  • Eugene K. Cha
  • Jonathan A. Coleman
Original Article



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.


Transfusion Intraoperative blood transfusion Surgery Urothelial carcinoma UTTCC 



Upper tract urothelial carcinoma


Radical nephroureterectomy


Overall survival


Cancer-specific survival


American Society of Anesthesiologists


Estimated blood loss


Authors’ contribution

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.

Supplementary material

345_2018_2180_MOESM1_ESM.docx (93 kb)
Supplementary material 1 (DOCX 93 kb)


  1. 1.
    Adibi M, Youssef R, Shariat SF, Lotan Y, Wood CG, Sagalowsky AI et al (2012) Oncological outcomes after radical nephroureterectomy for upper tract urothelial carcinoma: comparison over the three decades. Int J Urol 19(12):1060–1066CrossRefPubMedGoogle Scholar
  2. 2.
    Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E et al (2009) Outcomes of radical nephroureterectomy: a series from the upper tract urothelial carcinoma collaboration. Cancer 115(6):1224–1233CrossRefPubMedGoogle Scholar
  3. 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
  4. 4.
    Seisen T, Krasnow RE, Bellmunt J, Roupret M, Leow JJ, Lipsitz SR et al (2017) Effectiveness of adjuvant chemotherapy after radical nephroureterectomy for locally advanced and/or positive regional lymph node upper tract urothelial carcinoma. J Clin Oncol 35(8):852–860CrossRefPubMedGoogle Scholar
  5. 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
  6. 6.
    Roscigno M, Brausi M, Heidenreich A, Lotan Y, Margulis V, Shariat SF et al (2011) Lymphadenectomy at the time of nephroureterectomy for upper tract urothelial cancer. Eur Urol 60(4):776–783CrossRefPubMedGoogle Scholar
  7. 7.
    Rink M, Sharifi N, Fritsche HM, Aziz A, Miller F, Kluth LA et al (2014) Impact of preoperative anemia on oncologic outcomes of upper tract urothelial carcinoma treated with radical nephroureterectomy. J Urol 191(2):316–322CrossRefPubMedGoogle Scholar
  8. 8.
    Rieken M, Schubert T, Xylinas E, Kluth L, Roupret M, Trinh QD et al (2014) Association of perioperative blood transfusion with oncologic outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Eur J Surg Oncol 40(12):1693–1699CrossRefPubMedGoogle Scholar
  9. 9.
    Rink M, Soave A, Dahlem R, Aziz A, Al-Sayed F, Peine S et al (2016) Impact of perioperative allogenic blood transfusion on survival after radical nephroureterectomy for upper tract urothelial carcinoma. Clin Genitourin Cancer 14(1):96–104CrossRefPubMedGoogle Scholar
  10. 10.
    Abel EJ, Linder BJ, Bauman TM, Bauer RM, Thompson RH, Thapa P et al (2014) Perioperative blood transfusion and radical cystectomy: does timing of transfusion affect bladder cancer mortality? Eur Urol 66(6):1139–1147CrossRefPubMedGoogle Scholar
  11. 11.
    Linder BJ, Frank I, Cheville JC, Tollefson MK, Thompson RH, Tarrell RF et al (2013) The impact of perioperative blood transfusion on cancer recurrence and survival following radical cystectomy. Eur Urol 63(5):839–845CrossRefPubMedGoogle Scholar
  12. 12.
    Morgan TM, Barocas DA, Chang SS, Phillips SE, Salem S, Clark PE et al (2013) The relationship between perioperative blood transfusion and overall mortality in patients undergoing radical cystectomy for bladder cancer. Urol Oncol 31(6):871–877CrossRefPubMedGoogle Scholar
  13. 13.
    Vamvakas EC, Blajchman MA (2007) Transfusion-related immunomodulation (TRIM): an update. Blood Rev 21(6):327–348CrossRefPubMedGoogle Scholar
  14. 14.
    Pesta M, Fichtl J, Kulda V, Topolcan O, Treska V (2013) Monitoring of circulating tumor cells in patients undergoing surgery for hepatic metastases from colorectal cancer. Anticancer Res 33(5):2239–2243PubMedGoogle Scholar
  15. 15.
    Vamvakas EC (1996) Transfusion-associated cancer recurrence and postoperative infection: meta-analysis of randomized, controlled clinical trials. Transfusion 36(2):175–186CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Aditya Bagrodia
    • 1
  • Samuel Kaffenberger
    • 2
  • Andrew Winer
    • 2
  • Katie Murray
    • 2
  • Michael Vacchio
    • 2
  • Junting Zheng
    • 3
  • Irina Ostrovnaya
    • 3
  • Bernard H. Bochner
    • 2
  • Guido Dalbagni
    • 2
  • Eugene K. Cha
    • 2
  • Jonathan A. Coleman
    • 2
  1. 1.Department of UrologyUT Southwestern Medical CenterDallasUSA
  2. 2.Department of Surgery, Urology ServiceMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA

Personalised recommendations