The prognostic role of pre-cystectomy hemoglobin levels in patients with invasive bladder cancer

To determine whether pre-treatment hemoglobin (Hb) levels in patients with bladder cancer impact on oncological outcomes after radical cystectomy (RC).

A consecutive, contemporary series of 246 patients undergoing RC and pelvic lymph node dissection for bladder cancer.

Decreased Hb level was defined as ≤12 g/dL. The Kaplan-Meier method was used to estimate recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS). The Fisher exact/Chi-square test was used to investigate differences between both groups. Uni- and multivariable Cox regression analysis addressed risk factors for recurrence, cancer-specific death and overall death. The median follow-up was 30 months (2-116).

Of the 246 patients, 182 (74 %) had normal (>12 g/dL) and 64 decreased (≤12 g/dL) preoperative Hb (26 %). In univariable analysis, decreased Hb was associated with increased age, extravesical disease, hydronephrosis (all p < 0. 001), node-positive disease and positive resection margins (both p = 0. 01). Subanalyzed for patients with organ-confined disease (defined as ≤pT2bN0R0; N = 109), the 3-year RFS, CSS and OS was significantly lower in patients with decreased (34. 9, 35. 5 and 19. 8 %) compared to normal Hb level (69. 7, 86. 3 and 77. 6 %; p = 0. 01/p = 0. 002/p < 0. 001). In multivariable analysis, RFS, CSS and OS were significantly lower in patients with decreased Hb (p = 0. 007, p = 0. 001 and p = 0. 002), pathologically locally advanced tumor (≥pT3a; p = 0. 023, p = 0. 036 and p = 0. 065) and nodal stage (p < 0. 001, p = 0. 006 and p = 0. 001) and positive soft tissue surgical margins (p = 0. 040, p = 0. 004 and 0. 012).

Pre-cystectomy Hb levels are associated with adverse histopathologic characteristics and provide additional prognostic information especially for patients with pathologically localized bladder cancer.

World journal of urology. 2015 Sep 29 [Epub ahead of print]

Tina Schubert, Tilman Todenhöfer, Johannes Mischinger, Christian Schwentner, Markus Renninger, Arnulf Stenzl, Georgios Gakis

Department of Urology, Eberhard-Karls University Tuebingen, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.  Department of Urology, Eberhard-Karls University Tuebingen, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany. , Department of Urology, Eberhard-Karls University Tuebingen, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany. , Department of Urology, Eberhard-Karls University Tuebingen, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany. , Department of Urology, Eberhard-Karls University Tuebingen, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany. , Department of Urology, Eberhard-Karls University Tuebingen, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany. , Department of Urology, Eberhard-Karls University Tuebingen, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.

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