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Journal of Cancer Research and Clinical Oncology

, Volume 141, Issue 10, pp 1819–1826 | Cite as

Preoperative anemia is associated with adverse outcome in patients with urothelial carcinoma of the bladder following radical cystectomy

  • M. Gierth
  • R. Mayr
  • A. Aziz
  • S. Krieger
  • B. Wullich
  • A. Pycha
  • M. Lodde
  • U. Salvadori
  • J. Bründl
  • H. M. Fritsche
  • F. Hofstädter
  • M. T. Pawlik
  • W. Otto
  • M. May
  • M. Burger
  • S. Denzinger
Original Article – Clinical Oncology

Abstract

Purpose

Radical cystectomy (RC) can be associated with significant blood loss, whereas many patients are presenting with anemia preoperatively. To date, there is a lack of data addressing the impact of preoperative anemia (PA) on survival of patients undergoing RC for urothelial carcinoma of the bladder (UCB).

Methods

This retrospective multicenter study includes 684 patients with UCB undergoing RC with pelvic lymph node dissection. The median follow-up was 50 (IQR 29,78) months. Anemia was defined in line with the WHO classification (hemoglobin (Hb): male ≤13 g/dL, female ≤12 g/dL) and based on contemporary gender- and age-adjusted classification (Hb: white male aged <60 years: ≤13.7 g/dL; ≥60 years: ≤13.2 g/dL; white female of all ages ≤12.2 g/dL). Univariable and multivariable Cox regression analyses were used to assess the effects of PA on oncological outcomes.

Results

A total of 269 (39.3 %) and 302 (44.2 %) patients were anemic according to the WHO classification versus contemporary classification. Age, increased ECOG performance status, advanced tumor stages, lymph node metastasis, positive surgical margin and anemia were associated with disease recurrence (DR), cancer-specific mortality (CSM) and all-cause mortality (ACM). In multivariable analysis, anemia was an independent predictor of DR, CSM and ACM (WHO and/or contemporary classification). Blood transfusion was significantly associated with ACM in both classifications of anemia.

Conclusions

PA is significantly associated with worse oncological outcome in patients undergoing RC. Based on the additional unfavorable influence of blood transfusion, this emphasizes the importance of early diagnosis and correction of anemia and implementation of alternative methods of blood volume management.

Keywords

Bladder cancer Radical cystectomy Preoperative anemia Prognosis Survival 

Notes

Acknowledgments

We thank Christopher Naisbitt for his excellent assistance.

Conflict of interest

The authors declare that there are no financial or/and other conflicts of interest that might bias the submitted work.

Ethical standards

We confirm that this study has been approved by the appropriate ethical committees related to the institution(s) in which it was performed.

Informed consent

All patients gave their informed consent prior to their inclusion in the study.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • M. Gierth
    • 1
    • 8
  • R. Mayr
    • 1
  • A. Aziz
    • 1
  • S. Krieger
    • 2
  • B. Wullich
    • 2
  • A. Pycha
    • 3
  • M. Lodde
    • 3
  • U. Salvadori
    • 4
  • J. Bründl
    • 1
  • H. M. Fritsche
    • 1
  • F. Hofstädter
    • 5
  • M. T. Pawlik
    • 6
  • W. Otto
    • 1
  • M. May
    • 7
  • M. Burger
    • 1
  • S. Denzinger
    • 1
  1. 1.Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
  2. 2.Department of UrologyUniversity of ErlangenErlangenGermany
  3. 3.Department of UrologyCentral Hospital of BolzanoBolzanoItaly
  4. 4.Department of Immunohaematology and Transfusion MedicineCentral Hospital of BolzanoBolzanoItaly
  5. 5.Department of PathologyUniversity of RegensburgRegensburgGermany
  6. 6.Department of AnesthesiologySt. Josef Medical Center RegensburgRegensburgGermany
  7. 7.Department of UrologySt. Elisabeth Hospital StraubingStraubingGermany
  8. 8.Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany

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