TY - JOUR
T1 - Timing of blood transfusion and oncologic outcomes in patients treated with radical nephroureterectomy for upper tract urothelial carcinoma
AU - Bagrodia, Aditya
AU - Kaffenberger, Samuel
AU - Winer, Andrew
AU - Murray, Katie
AU - Vacchio, Michael
AU - Zheng, Junting
AU - Ostrovnaya, Irina
AU - Bochner, Bernard H.
AU - Dalbagni, Guido
AU - Cha, Eugene K.
AU - Coleman, Jonathan A.
N1 - Funding Information:
Funding 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.
Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - 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.
AB - 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.
KW - Intraoperative blood transfusion
KW - Surgery
KW - Transfusion
KW - UTTCC
KW - Urothelial carcinoma
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U2 - 10.1007/s00345-018-2180-3
DO - 10.1007/s00345-018-2180-3
M3 - Article
C2 - 29344681
AN - SCOPUS:85040658154
SN - 0724-4983
VL - 36
SP - 645
EP - 653
JO - World journal of urology
JF - World journal of urology
IS - 4
ER -