Association of perioperative blood transfusion with oncologic outcomes after radical nephroureterectomy for upper tract urothelial carcinoma.
BACKGROUND
To test the hypothesis that perioperative blood transfusion (PBT)impacts oncologic outcomes of patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).


METHODS
Retrospective analysis of 2492 patients with UTUC treated at 23 institutions with RNU between 1987 and 2007.Cox regression models addressed the association of PBT with disease recurrence, cancer-specific mortality and any-cause mortality.


RESULTS
A total of 510 patients (20.5%) patients received PBT. Within a median follow-up of 36 months (Interquartile range: 55 months), 663 (26.6%) patients experienced disease recurrence, 545 patients (21.9%) died of UTUC and 884 (35.5%) patients died from any cause. Patients who received PBT were at significantly higher risk of disease recurrence, cancer-specific mortality and overall mortality than patients not receiving PBT in univariable Cox regression analyses. In multivariable Cox regression analyses that adjusted for the effects of standard clinicopathologic features, PBT did not remain associated with disease recurrence (HR: 1.11; 95% CI 0.92-1.33, p = 0.25), cancer-specific mortality (HR: 1.09; 95% CI 0.89-1.33, p = 0.41) or overall mortality (HR: 1.09; 95% CI 0.93-1.28, p = 0.29).


CONCLUSIONS
In patients undergoing RNU for UTUC, PBT is associated with disease recurrence, cancer-specific survival or overall survival in univariable, but not in multivariable Cox regression analyses.
Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, University Hospital Basel, Basel, Switzerland.
M
M
Rieken
Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
T
T
Schubert
Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France.
E
E
Xylinas
Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
L
L
Kluth
Department of Urology, AP-HP, Hopital Pitié-Salpétrière, Service d'Urologie, Paris, France; UPMC Univ. Paris 06, GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, Paris, France.
M
M
Rouprêt
Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Q-D
QD
Trinh
Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
R K
RK
Lee
Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
B
B
Al Hussein Al Awamlh
Department of Urology, Medical University of Vienna, Vienna, Austria.
H
H
Fajkovic
Department of Surgical, Oncological and Gastroenterologic Sciences, Urology Clinic, University of Padua, Italy.
G
G
Novara
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
V
V
Margulis
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Y
Y
Lotan
Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
J I
JI
Martinez-Salamanca
Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
K
K
Matsumoto
Department of Urology, Medical University of Vienna, Vienna, Austria.
C
C
Seitz
Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria.
M
M
Remzi
Department of Urology, University of Montreal, Montreal, QC, Canada.
P I
PI
Karakiewicz
Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
D S
DS
Scherr
Department of Urology, Vita-Salute University, Milan, Italy.
A
A
Briganti
Department of Urology, University Hospital Basel, Basel, Switzerland.
A
A
Bachmann
Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: sfshariat@gmail.com.
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SF
Shariat
D000368:Aged; D001803:Blood Transfusion; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D059035:Perioperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D019043:Vascular Neoplasms / Q000556:secondary
Blood transfusion; Disease recurrence; Radical nephroureterectomy; Surgery outcomes; Upper tract urothelial carcinoma