Prognostic Impact of Preoperative Anemia on Urothelial and Extraurothelial Recurrence in Patients With Upper Tract Urothelial Carcinoma.
BACKGROUND
To investigate the prognostic impact of preoperative anemia on urothelial and extraurothelial recurrence after radical nephroureterectomy.


METHODS
A single-center series of 238 consecutive patients who were treated with radical nephroureterectomy for upper tract urothelial carcinoma was evaluated. We categorized patients on the basis of hemoglobin level into 2 groups, including normal or anemia. Survival was estimated using the Kaplan-Meier method. Cox proportional hazard regression models were used to evaluate the association of preoperative anemia with outcome, controlling for clinicopathologic variables.


RESULTS
Ninety-seven patients (40.8%) had anemia (median hemoglobin level, 143 vs. 107 g/L). Preoperative anemia was associated with history of bladder cancer (P = .01), tumor multifocality (P = .03), lymphovascular invasion (P = .05), and adjuvant chemotherapy (P = .01). Higher tumor stage and grade, and lymph node metastasis were significantly associated with preoperative anemia. Preoperative anemia was independently associated with extraurothelial recurrence (hazard ratio, 1.95; 95% confidence interval, 1.14-3.34; P = .01) in multivariate Cox regression analyses. Only a history of bladder tumor (hazard ratio, 2.07; P = .009) and tumor multifocality (hazard ratio, 3.97; 95% confidence interval, 2.37-6.67; P < .001) were independently associated with urothelial recurrence. The 5-year cancer-specific survival for patients with normal hemoglobin level was 82.1% and for patients with preoperative anemia was 54.2%.


CONCLUSIONS
Patients with preoperative anemia had a greater probability of having upper tract urothelial carcinoma with higher tumor stages, higher tumor grades, and lymph node metastasis (pN+). Preoperative anemia was statistically significantly associated with worse cancer-specific survival and extraurothelial recurrence in patients who underwent radical nephroureterectomy.
Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia. Electronic address: em2bogomir@yahoo.com.
Bogomir
B
Milojevic
Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
Zoran
Z
Dzamic
Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
Boris
B
Kajmakovic
Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
Otas
O
Durutovic
Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
Uros
U
Bumbasirevic
Institute of Epidemiology, School of Medicine, University of Belgrade, Belgrade, Serbia.
Sandra
S
Sipetic Grujicic
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D057234:Preoperative Period; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000473:pathology* / Q000601:surgery*; D019459:Urothelium / Q000473:pathology* / Q000601:surgery
Anemia; Radical nephroureterectomy; Recurrence; Survival; Upper urinary tract urothelial carcinoma