Prognostic Value of Preoperative Anemia on Survival and Recurrence in Patients with Bladder Carcinoma Treated by Radical Cystectomy.

BACKGROUND

Preoperative anemia (PA) has been recognized as a potential prognostic biomarker in various urologic malignancies; however, its significance in patients with bladder carcinoma undergoing radical cystectomy (RC) remains insufficiently defined. This study aimed to evaluate the prognostic value of PA on survival and recurrence outcomes in patients treated with RC.

METHODS

A retrospective analysis was conducted on 299 patients who underwent RC for nonmetastatic bladder cancer between 2015 and 2018. Patients were stratified into anemia and nonanemia groups based on age- and sex-adjusted hemoglobin thresholds. Clinicopathologic characteristics were compared. The impact of PA on overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) was assessed by using Kaplan-Meier analysis and Cox proportional hazards models.

RESULTS

Preoperative anemia was present in 159 patients (53.2%) and was significantly associated with adverse clinicopathologic factors, including higher tumor stage, higher tumor grade, lymphovascular invasion, hydronephrosis, hypoalbuminemia, and thrombocytosis (all p < 0.05). In univariate analyses, PA was associated with worse OS (hazard ratio [HR] 2.199, p < 0.001), CSS (HR 2.345, p < 0.001), and RFS (HR 1.955, p = 0.005). Multivariate analyses confirmed PA as an independent predictor of OS (HR 1.455, p = 0.022), CSS (HR 1.566, p = 0.010), and RFS (HR 1.622, p = 0.044). Kaplan-Meier curves demonstrated significantly poorer survival outcomes across all endpoints in anemic patients. The 5-year CSS estimate was 35.8% in patients with PA.

CONCLUSIONS

Preoperative anemia is an independent adverse prognostic factor for survival and recurrence in patients with bladder carcinoma treated with radical cystectomy.