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
  • 41 Downloads

Abstract

Purpose

To evaluate the impact of timing of blood transfusion in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).

Methods

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.

Results

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).

Conclusions

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.

Keywords

Transfusion Intraoperative blood transfusion Surgery Urothelial carcinoma UTTCC 

Abbreviations

UTUC

Upper tract urothelial carcinoma

RNU

Radical nephroureterectomy

OS

Overall survival

CSS

Cancer-specific survival

ASA

American Society of Anesthesiologists

EBL

Estimated blood loss

Notes

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.

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)

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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

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