Preoperative anemia is associated with disease recurrence and progression in patients with non–muscle-invasive bladder cancer

• Published in: Urologic oncology 2017-03, Vol.35 (3), p.113.e9-113.e14
• Main Authors: Soria, Francesco, M.D, Moschini, Marco, M.D, Abufaraj, Mohammad, M.D, Wirth, Gregory J., M.D, Foerster, Beat, M.D, Gust, Kilian M., M.D, Özsoy, Mehmet, M.D, Briganti, Alberto, M.D, Gontero, Paolo, M.D, Mathieu, Romain, M.D, Rouprêt, Morgan, M.D, Karakiewicz, Pierre I., M.D, Shariat, Shahrokh F., M.D
• Format: Article
• Language: English
• Subjects: Administration, Intravesical; Aged; Anemia - epidemiology; Anemia - etiology; Chemotherapy, Adjuvant - methods; Cystectomy - methods; Disease Progression; Disease-Free Survival; Female; Humans; Male; Middle Aged; Muscles - pathology; Neoplasm Grading; Neoplasm Recurrence, Local - blood; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Preoperative Period; Prognosis; Proportional Hazards Models; Retrospective Studies; Urinary Bladder - pathology; Urinary Bladder Neoplasms - blood; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - therapy; Urology
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2016.10.021

Abstract Purpose To evaluate the effect of preoperative anemia (PA) on oncological outcomes in a multicenter cohort of patients with non–muscle-invasive bladder cancer (NMIBC) treated with transurethral resection of the bladder (TURB) and adjuvant intravesical therapies. We hypothesize that PA represents a marker of disease aggressiveness and could be used to improve the discrimination of prognostic tools for the prediction of disease recurrence and progression. Methods This multicenter retrospective study included 1,117 patients from 4 different centers. The presence of PA was assessed according to the World Health Organization classification as a preoperative hemoglobin level of≤13 g/dl in men and≤12 g/dl in women. PA evaluation was done at each institution, generally 1 to 3 days before surgery. Multivariable Cox regression models were performed to evaluate the prognostic effect of PA on survival outcomes. Results Overall, 381 (34%) patients with NMIBC treated with TURB, had PA. Median follow-up for patients alive at last follow-up was 62.7 months (interquartile range: 25–110.7). On multivariable Cox regression analyses that accounted for the effect of standard clinicopathologic prognosticators, PA was independently associated with recurrence-free survival ( P = 0.045) and progression-free survival ( P = 0.01). Adding PA to a model for the prediction of disease recurrence and progression improved the discrimination of the prognostic models marginally from 69.8% to 70.3% and from 71.6% to 73.1%, respectively. Conclusions PA was found in more than one-third of patients with NMIBC treated with TURB. PA was associated with poor oncological outcomes and was an independent predictor of intravesical disease recurrence and progression. However, the additional prognostic information provided by PA remains limited.