Prognostic impact of preoperative hematological disorders and a risk stratification model in bladder cancer patients treated with radical cystectomy

Abstract

Abbreviations & Acronyms ASA = American Society of Anesthesiologists BCa = bladder cancer BMI = body mass index CCI = Charlson Comorbidity Index CI = confidential interval CRP = C-reactive protein DSS = disease-specific survival ECOG = Eastern Cooperative Oncology Group eGFR = estimated glomerular filtration rate HB = hemoglobin HR = hazard ratio LDH = lactate dehydrogenase LNM = lymph node metastasis LVI = lympho-vascular invasion NA = not available PS = performance status PSM = positive surgical margin RC = radical cystectomy SD = standard deviation Objectives: The present study investigated prognostic indicators, including clinicopathological and preoperative hematological factors, and developed a prognostic factorbased risk stratification model in bladder cancer patients treated with radical cystectomy. Methods: Data were collected from 249 consecutive bladder cancer patients treated with radical cystectomy without neoadjuvant therapy. Prognostic values of the preoperative hematological parameters, along with the patients' clinicopathological parameters were evaluated. A risk stratification model was developed to predict disease-specific survival after radical cystectomy using the regression coefficients of multivariate analysis. Results: In the multivariate analysis, preoperative hemoglobin and C-reactive protein levels, as well as the pathological factors of T stage, positive surgical margin and lymph node metastasis, were independently predictive of disease-specific survival. Low hemoglobin (<10.5 g/dL), a high C-reactive protein (>0.5 mg/dL), extravesical T stage (≥pT3a) and positive surgical margin were independent predictors of poor disease-specific survival. The risk stratification model showed significant differences in disease-specific survival between the three subgroups. Conclusions: This is the first report to show the significance of combining preoperative hemoglobin with the pathology of radical cystectomy specimens as an independent predictor for disease-specific survival, and it also represents the largest contemporary series to date demonstrating that two types of preoperative hematological disorders, assessed by hemoglobin and C-reactive protein, are independent predictors in bladder cancer patients treated with radical cystectomy. Our risk stratification model could provide physicians with useful prognostic information for identifying patients who might be candidates for multimodal treatments.

Use of preoperative performance status and hemoglobin concentration to predict overall survival for patients aged ≥75 years after radical cystectomy for treatment of bladder cancer

“…Previous work has found an association between clinical outcomes after RC and PS, namely Karnofsky PS [5] and ECOG PS [16]. The preoperative Hb concentration is reported to be associated with disease-specific survival of patients treated with RC [17,18]. Consistent with previous data, we found that ECOG PS and preoperative Hb level were associated with OS after RC for the entire cohort (Tables 3, 5).…”

C-reactive protein in urologic cancers

“…Another model incorporated preoperative hemoglobin (<10.5 g/dL), elevated CRP (>5.0 mg/L), pathologic T stage (≥pT3a), positive surgical margin, and nodal disease, all of which were independently prognostic of cancerspecific survival in bladder cancer, into a risk stratification model. The 4-year cancer-specific survival for low risk, intermediate risk, and high risk patients was 77.7%, 23.6%, and 7.4%, respectively (Sejima et al, 2014). When various pairs out of the three separate risk groups were compared, differences were noted to be significant.…”

Role of adjuvant chemotherapy for lymph node‐positive upper tract urothelial carcinoma and the prognostic significance of C‐reactive protein: A multi‐institutional, retrospective study

“…Sejima et al . also reported that CRP elevation above 0.5 mg/dL was associated with poor prognosis in the patients with bladder cancer treated with radical cystectomy . LN‐positive patients with low preoperative CRP levels might derive survival benefits from AC, after RNU, and this option should be offered to them.…”