Impact of Perioperative Allogenic Blood Transfusion on Survival After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma.
The present retrospective multicenter study analyzed the effect of perioperative blood transfusions (PBTs) on the outcomes in 285 patients with upper tract urothelial carcinoma who had undergone radical nephroureterectomy (RNU). We found that patients receiving PBTs had inferior survival compared with that of patients without PBTs. Future investigations should focus on optimization of preoperative hemoglobin levels, surgical accuracy, and anesthetic management of RNU.


BACKGROUND
Preoperative anemia is an independent predictor for unfavorable outcomes in patients with upper tract urothelial carcinoma (UTUC) who undergo radical nephroureterectomy (RNU). The effect of perioperative blood transfusion (PBT) on survival, however, has been insufficiently investigated. We investigated the impact of PBT on the outcomes of patients UTUC treated with RNU.


METHODS
We analyzed the data from 285 patients with UTUC who had undergone RNU at 3 German academic institutions. PBT administration was analyzed as a dichotomous variable (administered vs. not administered) and the number of PBT units as a continuous and categorical variable (0 vs. ≤ 2 vs. > 2). Cox regression models were used to analyze the impact of PBT on disease recurrence and survival.


RESULTS
A total of 81 patients (28.4%) had received a PBT with a median number of 2 U (interquartile range, 2-4). The administration of PBT was associated with advanced tumor stage, higher tumor grade, and preoperative anemia (P ≤ .049 for all). At a mean follow-up of 52 months, PBT and an increasing number of PBT units were significantly associated with inferior overall survival (P ≤ .025). On multivariable analyses adjusted for established UTUC outcome prognosticators, PBT was significantly associated with inferior overall survival (hazard ratio, 1.6; 95% confidence interval, 1.055-2.428; P = .027).


CONCLUSIONS
PBT is an independent risk factor for worse overall survival in patients with UTUC treated with RNU. Continued efforts are warranted to optimize patients' preoperative hemoglobin level, surgical accuracy, and anesthetic management of RNU to reduce the necessity for PBTs.
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: mrink@uke.de.
Michael
M
Rink
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Armin
A
Soave
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Roland
R
Dahlem
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Caritas St. Josef Hospital, University of Regensburg, Regensburg, Germany.
Atiqullah
A
Aziz
Department of Urology, University Hospital Tübingen, Tübingen, Germany.
Fahmy
F
Al-Sayed
Institute of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Sven
S
Peine
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Oliver
O
Engel
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Luis A
LA
Kluth
Department of Urology, University Hospital Tübingen, Tübingen, Germany.
Arnulf
A
Stenzl
Department of Urology, Caritas St. Josef Hospital, University of Regensburg, Regensburg, Germany.
Maximilian
M
Burger
Department of Urology, Medical University Vienna, Vienna, Austria.
Shahrokh F
SF
Shariat
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Margit
M
Fisch
Department of Urology, University Hospital Tübingen, Tübingen, Germany.
Hans-Martin
HM
Fritsche
Department of Urology, University Hospital Tübingen, Tübingen, Germany.
Georgios
G
Gakis
D000368:Aged; D000740:Anemia / Q000628:therapy*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002277:Carcinoma / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy; D059035:Perioperative Period; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014571:Urologic Neoplasms / Q000401:mortality / Q000601:surgery*; D019459:Urothelium / Q000473:pathology
Anemia; Perioperative blood transfusion; Prognosis; Upper urinary tract; Urothelial cancer