- Email: [email protected]
21 Association of perioperative blood transfusion with oncologic outcomes after radical nephroureterectomy for upper tract urothelial carcinoma
21
Association of perioperative blood transfusion with oncologic outcomes after radical nephroureterectomy for upper tract urothelial carcinoma Eur Urol Suppl 2014;13;e21
Print! Print!
Rieken M. 1 , Schubert T.2 , Xylinas E. 1 , Kluth L. 1 , Rouprêt M. 3 , Quoc-Dien T.4 , Lee R.K. 5 , Al Hussein Al Awamlh B. 1 , Fajkovic H.6 , Novara G.7 , Margulis V. 8 , Lotan Y. 8 , Martinez-Salamanca J. 9 , Matsumoto K. 10 , Seitz C.6 , Remzi M. 11 , Karakiewicz P. 12 , Scherr D.1 , Briganti A. 13 , Bachmann A. 14 , Shariat S.F. 6 1 Weill
Cornell Medical College, Dept. of Urology, New York, United States of America, 2 Weill Cornell Medical College, Dept.of Urology,
New York, United States of America, 3 AP-HP, Hopital Pitié-Salpétrière, Dept. of Urology, Paris, France, 4 Harvard Medical School, Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital / Dana-Farber Cancer Institute, Boston, United States of America, 5 Weill Cornell Medical College, Dept. of Urology, New York, United States of America, 6 Medical University of Vienna, Dept. of Urology, Vienna, Austria, 7 University of Padua, Dept. of Surgical, Oncological and Gastroenterologic Sciences, Urology Clinic, Padua, Italy, 8 University of Texas Southwestern Medical Center, Dept. of Urology, Dallas, United States of America, 9 Hospital Universitario Puerta De Hierro-Majadahonda, Universidad Autónoma De Madrid, Dept. of Urology, Madrid, Spain, 10 Kitasato University School of Medicine, Dept. of Urology, Sagamihara, Kanagawa, Japan, 11 Landesklinikum Korneuburg, Dept. of Urology, Korneuburg, Austria, 12 University of Montreal, Dept. of Urology, Montreal, Canada, 13 Vita-Salute University, Dept. of Urology, Milan, Italy, 14 University Hospital Basel, Dept. of Urology, Basel, Switzerland INTRODUCTION & OBJECTIVES: Evidence suggests a detrimental effect of perioperative blood transfusion (PBT) on various cancer outcomes. To date, the effect of PBT on upper tract urothelial carcinoma (UTUC) remains uninvestigated. We tested the hypothesis that PBT impacts oncologic outcomes of patients treated with radical nephroureterectomy (RNU) for UTUC. MATERIAL & METHODS: We performed a retrospective analysis of 2492 patients with UTUC treated at 23 institutions with RNU without neoadjuvant therapy between 1987 and 2007. Cox regression models addressed the association of PBT with disease recurrence, cancerspecific mortality and any-cause mortality. RESULTS: A total of 510 patients (20.5%) received PBT. There were no differences in clinicopathologic features except tumor stage (p<0.001) and history of previous UCB (p=0.04), which was higher in patients receiving PBT. Within a median follow-up of 36 months (Interquartile range: 9-64 months), 663 (26.6%) patients experienced disease recurrence, 545 patients (21.9%) died of UTUC and 884 (35.5%) patients died from any cause. Actuarial estimate of 5-year recurrence-free survival was 72% ± 1 (standard error) and 63% ± 1 for patients not receiving and receiving PBT, respectively (p=0.001). Actuarial estimate of 5-year cancer-specific and overall survival was 76% ± 1 and 66% ± 1 for patients not receiving PBT and 67% ± 2 and 57% ± 3 for patients receiving PBT, respectively (p<0.001). 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). In a subgroup analysis of patients with organ-confined and non organ-confined UTUC, PBT was not independently associated with disease recurrence, cancer-specific mortality or overall mortality. 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. It appears likely that not PBT itself, but the circumstances leading to PBT are prognosticators of outcome in UTUC patients.
Association of perioperative blood transfusion with oncologic outcomes after radical nephroureterectomy for upper tract urothelial carcinoma Eur Urol Suppl 2014;13;e21
Print! Print!
Rieken M. 1 , Schubert T.2 , Xylinas E. 1 , Kluth L. 1 , Rouprêt M. 3 , Quoc-Dien T.4 , Lee R.K. 5 , Al Hussein Al Awamlh B. 1 , Fajkovic H.6 , Novara G.7 , Margulis V. 8 , Lotan Y. 8 , Martinez-Salamanca J. 9 , Matsumoto K. 10 , Seitz C.6 , Remzi M. 11 , Karakiewicz P. 12 , Scherr D.1 , Briganti A. 13 , Bachmann A. 14 , Shariat S.F. 6 1 Weill
Cornell Medical College, Dept. of Urology, New York, United States of America, 2 Weill Cornell Medical College, Dept.of Urology,
New York, United States of America, 3 AP-HP, Hopital Pitié-Salpétrière, Dept. of Urology, Paris, France, 4 Harvard Medical School, Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital / Dana-Farber Cancer Institute, Boston, United States of America, 5 Weill Cornell Medical College, Dept. of Urology, New York, United States of America, 6 Medical University of Vienna, Dept. of Urology, Vienna, Austria, 7 University of Padua, Dept. of Surgical, Oncological and Gastroenterologic Sciences, Urology Clinic, Padua, Italy, 8 University of Texas Southwestern Medical Center, Dept. of Urology, Dallas, United States of America, 9 Hospital Universitario Puerta De Hierro-Majadahonda, Universidad Autónoma De Madrid, Dept. of Urology, Madrid, Spain, 10 Kitasato University School of Medicine, Dept. of Urology, Sagamihara, Kanagawa, Japan, 11 Landesklinikum Korneuburg, Dept. of Urology, Korneuburg, Austria, 12 University of Montreal, Dept. of Urology, Montreal, Canada, 13 Vita-Salute University, Dept. of Urology, Milan, Italy, 14 University Hospital Basel, Dept. of Urology, Basel, Switzerland INTRODUCTION & OBJECTIVES: Evidence suggests a detrimental effect of perioperative blood transfusion (PBT) on various cancer outcomes. To date, the effect of PBT on upper tract urothelial carcinoma (UTUC) remains uninvestigated. We tested the hypothesis that PBT impacts oncologic outcomes of patients treated with radical nephroureterectomy (RNU) for UTUC. MATERIAL & METHODS: We performed a retrospective analysis of 2492 patients with UTUC treated at 23 institutions with RNU without neoadjuvant therapy between 1987 and 2007. Cox regression models addressed the association of PBT with disease recurrence, cancerspecific mortality and any-cause mortality. RESULTS: A total of 510 patients (20.5%) received PBT. There were no differences in clinicopathologic features except tumor stage (p<0.001) and history of previous UCB (p=0.04), which was higher in patients receiving PBT. Within a median follow-up of 36 months (Interquartile range: 9-64 months), 663 (26.6%) patients experienced disease recurrence, 545 patients (21.9%) died of UTUC and 884 (35.5%) patients died from any cause. Actuarial estimate of 5-year recurrence-free survival was 72% ± 1 (standard error) and 63% ± 1 for patients not receiving and receiving PBT, respectively (p=0.001). Actuarial estimate of 5-year cancer-specific and overall survival was 76% ± 1 and 66% ± 1 for patients not receiving PBT and 67% ± 2 and 57% ± 3 for patients receiving PBT, respectively (p<0.001). 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). In a subgroup analysis of patients with organ-confined and non organ-confined UTUC, PBT was not independently associated with disease recurrence, cancer-specific mortality or overall mortality. 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. It appears likely that not PBT itself, but the circumstances leading to PBT are prognosticators of outcome in UTUC patients.