title: Impact of preoperative hemoglobin and CRP levels on cancer-specific survival in patients undergoing radical cystectomy for transitional cell carcinoma of the bladder: results of a single-center study.
abstract: OBJECTIVE
  Different blood parameters have shown to be associated with patient's oncological outcome. There is only limited knowledge about the prognostic relevance of routine blood parameters in patients undergoing radical cystectomy for transitional cell carcinoma (TCC). Therefore, we retrospectively analyzed the influence of preoperative C-reactive protein (CRP) and hemoglobin (Hb) levels on overall survival (OS) and cancer-specific survival (CSS).
  
  
  METHODS
  Preoperative CRP and Hb levels were available in 664 patients who underwent RC due to TCC from 2004 to 2013 at our institution. More men than women (77 vs. 23 %) underwent surgery with a median age of 70 years (35-97). Median follow-up time was 24 months (max. 108). Outcome was analyzed using Kaplan-Meier method, log-rank test, and Cox regression models.
  
  
  RESULTS
  Median CRP level was 0.5 mg/dl (0.1-28.3), and median Hb level was 13.4 g/dl (6.7-17.9). Patients with CRP value above the median died significantly earlier due to their disease than those with CRP below the median (median CSS 19 vs. 70 months; p < 0.001). Patients with preoperative Hb level below the median had significantly worse outcome than those with Hb level above the median (median CSS 25 vs. 78 months; p < 0.001). In multivariate analysis, CRP and Hb levels were independent prognostic parameters regarding CSS/OS (CRP p = 0.016/p = 0.004; Hb p = 0.006/p = 0.004, respectively).
  
  
  CONCLUSIONS
  In our single-center study, preoperative CRP and Hb levels were found to be independent prognostic factors, indicating impaired outcome in patients undergoing RC for TCC. These findings could be used for individual risk stratification and optimization of therapeutic strategies.
authors.affiliation: Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Grimm
authors.affiliation: Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Buchner
authors.affiliation: Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schneevoigt
authors.affiliation: Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Kretschmer
authors.affiliation: Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Apfelbeck
authors.affiliation: Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany. markus.grabbert@med.uni-muenchen.de.
authors.forename: M
authors.initials: M
authors.lastname: Grabbert
authors.affiliation: Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany.
authors.forename: J F
authors.initials: JF
authors.lastname: Jokisch
authors.affiliation: Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany.
authors.forename: C G
authors.initials: CG
authors.lastname: Stief
authors.affiliation: Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Karl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis*; D002295:Carcinoma, Transitional Cell / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D015653:Cystectomy / Q000379:methods; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery*
chemical_list: D006454:Hemoglobins; D002097:C-Reactive Protein
keywords: C-reactive protein; Hemoglobin; Muscle-invasive transitional cell carcinoma of the bladder; Prognostic factors; Radical cystectomy