DOI QR코드

DOI QR Code

Predictive Effect of Preoperative Anemia on Long-Term Survival Outcomes with Non-Muscle Invasive Bladder Cancer

  • Celik, Orcun (Department of Urology, Tepecik Education and Research Hospital) ;
  • Akand, Murat (Department of Urology, School of Medicine, Selcuk University) ;
  • Keskin, Mehmet Zeynel (Department of Urology, Tepecik Education and Research Hospital) ;
  • Ekin, Rahmi Gokhan (Department of Urology, Tepecik Education and Research Hospital) ;
  • Yoldas, Mehmet (Department of Urology, Tepecik Education and Research Hospital) ;
  • Ilbey, Yusuf Ozlem (Department of Urology, Tepecik Education and Research Hospital)
  • Published : 2016.06.01

Abstract

Background: Anemia is the most common hematologic abnormality in bladder cancer (BC) patients. We evaluated the impact of preoperative anemia on oncologic outcomes in BC undergoing transurethral resection of a bladder tumor (TURBT) for the first time diagnosis. Materials and Methods: We retrospectively evaluated the data collected from 639 patients who underwent TURBT between January 2006 and September 2014 in our department. Of these patients, 320 qualified for inclusion in the study. The primary efficacy endpoint was the effect of preoperative anemia status on cancer-specific and overall survival. Independent t-test and chi-square analyses were performed to assess the effects of anemia on oncologic outcomes. Survival was estimated by using the Kaplan-Meier test. Results: There were 118 (36.9%) and 202 (63.1%) patients in the anemia (Group-1) and non-anemia groups (Group-2), respectively. The median follow-up duration was 68 months. Anemia was associated with decreased overall survival (p<0.001). Comparison between cancer-specific survival of two groups did not show any statistically significant difference (p=0.17). Conclusions: Preoperative anemia status of BC patients according to World Health Organization classification is associated with decreased overall survival, but not with cancer-specific survival. We think that preoperative hemoglobin levels should be considered in patient counseling and decision-making for additional therapy.

Keywords

References

  1. Babjuk M, Burger M, Zigeuner R, et al (2013). EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol, 64, 639-53. https://doi.org/10.1016/j.eururo.2013.06.003
  2. Basiri A, Shakhssalim N, Jalaly NY, et al (2014). Difference in the incidences of the most prevalent urologic cancers from 2003 to 2009 in Iran. Asian Pac J Cancer Prev, 15, 1459-63. https://doi.org/10.7314/APJCP.2014.15.3.1459
  3. Beutler E, Waalen J (2006). The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood, 107, 1747-50. https://doi.org/10.1182/blood-2005-07-3046
  4. Birgegard G, Aapro MS, Bokemeyer C, et al (2005). Cancerrelated anemia: pathogenesis, prevalence and treatment. Oncol, 68, 3-11. https://doi.org/10.1159/000083128
  5. Burger M, Catto JW, Dalbagni G, et al (2013). Epidemiology and risk factors of urothelial bladder cancer. Eur Urol, 63, 234-41. https://doi.org/10.1016/j.eururo.2012.07.033
  6. Gierth M, Mayr R, Aziz A, et al (2015). Preoperative anemia is associated with adverse outcome in patients with urothelial carcinoma of the bladder following radical cystectomy. J Cancer Res Clin Oncol, 141, 1819-26. https://doi.org/10.1007/s00432-015-1957-7
  7. Hutterer GC, Krieger D, Mrsic E, et al (2015). Preoperative leukocytosis, thrombocytosis and anemia as potential prognostic factors in non-metastatic renal cell carcinoma. Anticancer Res, 35, 3463-9.
  8. Ikeda M, Matsumoto K, Nishi M, et al (2014). Comparison of radical cystectomy and chemoradiotherapy in patients with locally advanced bladder cancer. Asian Pac J Cancer Prev, 15, 6519-24. https://doi.org/10.7314/APJCP.2014.15.16.6519
  9. Kikuchi E, Margulis V, Karakiewicz P, et al (2009). Lymphovascular invasion predicts clinical outcomes in patients with node-negative upper tract urothelial carcinoma. J Clin Oncol, 27, 612-8. https://doi.org/10.1200/JCO.2008.17.2361
  10. Lammers RJ, Hendriks JC, Rodriguez Faba OR, et al (2016). Prediction model for recurrence probabilities after intravesical chemotherapy in patients with intermediaterisk non-muscle-invasive bladder cancer, including external validation. World J Urol, 34, 173-80. https://doi.org/10.1007/s00345-015-1598-0
  11. Mercadante S, Gebbia V, Marrazzo A, Filosto S (2000). Anemia in cancer: pathophysiology and treatment. Cancer Treat Rev, 26, 303-11. https://doi.org/10.1053/ctrv.2000.0181
  12. Milojevic B, Dzamic Z, Kajmakovic B, et al (2015). Prognostic impact of preoperative anemia on urothelial and extraurothelial recurrence in patients with upper tract urothelial carcinoma. Clin Genitourin Cancer, 13, 485-91. https://doi.org/10.1016/j.clgc.2015.03.007
  13. Pagano F, Bassi P, Galetti TP, et al (1991). Results of contemporary radical cystectomy for invasive bladder cancer: a clinicopathological study with an emphasis on the inadequacy of the tumor, nodes and metastases classification. J Urol, 145, 45-50. https://doi.org/10.1016/S0022-5347(17)38244-7
  14. Panneerselvam J, Park HK, Zhang J, et al (2012). FAVL impairment of the Fanconi anemia pathway promotes the development of human bladder cancer. Cell Cycle, 11, 2947-55. https://doi.org/10.4161/cc.21400
  15. Rink M, Cha EK, Green D, et al (2012a). Biomolecular predictors of urothelial cancer behavior and treatment outcomes. Curr Urol Rep, 13, 122-35. https://doi.org/10.1007/s11934-012-0237-1
  16. Rink M, Fajkovic H, Cha EK, et al (2012b). Death certificates are valid for the determination of cause of death in patients with upper and lower tract urothelial carcinoma. Eur Urol, 61, 854-5. https://doi.org/10.1016/j.eururo.2011.12.055
  17. Rink M, Sharifi N, Fritsche HM, et al (2014). Impact of preoperative anemia on oncologic outcomes of upper tract urothelial carcinoma treated with radical nephroureterectomy. J Urol, 191, 316-22. https://doi.org/10.1016/j.juro.2013.09.010
  18. Thrasher JB, Frazier HA, Robertson JE, Dodge RK, Paulson DF (1994). Clinical variables which serve as predictors of cancer-specific survival among patients treated with radical cystectomy for transitional cell carcinoma of the bladder and prostate. Cancer, 73, 1708-15. https://doi.org/10.1002/1097-0142(19940315)73:6<1708::AID-CNCR2820730626>3.0.CO;2-J
  19. Van Belle SJ, Cocquyt V (2003). Impact of hemoglobin levels on the outcome of cancers treated with chemotherapy. Crit Rev Oncol Hematol, 47, 1-11. https://doi.org/10.1016/S1040-8428(03)00093-3

Cited by

  1. Prognostic implications of preoperative anemia in urothelial carcinoma: A meta-analysis vol.12, pp.2, 2017, https://doi.org/10.1371/journal.pone.0171701
  2. Prognostic impact of preoperative anemia on non-muscle-invasive bladder carcinoma treated with GreenLight laser vaporization vol.32, pp.2, 2017, https://doi.org/10.1007/s10103-016-2133-2
  3. Prognostic value of impaired estimated glomerular filtration rate in intravesical BCG-treated non–muscle-invasive bladder cancer patients vol.7, pp.1, 2017, https://doi.org/10.1038/s41598-017-01532-7