title: Anaemia is associated with poor overall survival but not with inferior local control in patients with muscle invasive bladder carcinoma treated by radical external beam radiotherapy. A retrospective study.
abstract: OBJECTIVE
  The treatment of muscle invasive transitional cell carcinoma of the bladder with radiotherapy allows organ preservation and is frequently used in the UK, especially in patients not medically fit for cystectomy. Anaemia is known to be an indicator of a poor response to radiotherapy in head and neck and cervical carcinomas. Here we describe the prevalence and type of anaemia in patients with transitional cell carcinoma of the bladder and determine the effect anaemia has on treatment outcome.
  
  
  METHODS
  A retrospective review of notes was carried out on patients treated radically between 1992 and 1997. Potential patient, tumour and treatment prognostic indicators were reported. Patients were labelled as being anaemic if their pre-treatment haemoglobin level was below the normal range (below 13.5 g/dl for men and below 11.5 g/dl for women). The time to local failure, metastases and overall survival were recorded. Recurrence-free survival and overall survival actuarial estimations were carried out using the Kaplan-Meier method and compared by Log-rank testing. A multivariate analysis was carried out using the Cox regression method.
  
  
  RESULTS
  Data on 100 patients were available for analysis. Most of the patients were not adequately staged by today's standards. Fifty-two patients were anaemic, with 75% of them having a normochromic, normocytic anaemia. The univariate analysis showed no significant difference in the time to local recurrence, a trend towards a shorter time to metastases and a significant reduction in overall survival in anaemic patients (P = 0.001). Two-year survival was 43% and 22% for non-anaemic and anaemic patients, respectively. A multivariate analysis using the covariates tumour stage, grade and serum creatinine found anaemia to be a poor prognostic indicator for overall survival (P = 0.005).
  
  
  CONCLUSIONS
  Anaemia is highly prevalent in patients with bladder cancer. This retrospective study showed anaemic patients to have a worse outcome with radiotherapy treatment than patients with a normal haemoglobin level. This was not accounted for by a difference in local control, which may be expected from hypoxic radiobiological principles. Anaemia may be indicative of more aggressive malignancy or subclinical metastases.
authors.affiliation: Department of Oncology, Leicester Royal Infirmary, Leicester, UK. joynsonc@doctors.org.uk
authors.forename: C P
authors.initials: CP
authors.lastname: Joynson
authors.forename: S
authors.initials: S
authors.lastname: Sundar
authors.forename: P
authors.initials: P
authors.lastname: Symonds
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications*; D002277:Carcinoma / Q000532:radiotherapy*; D002295:Carcinoma, Transitional Cell / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D000860:Hypoxia; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy*; D014549:Urinary Incontinence