title: The prognostic role of pre-cystectomy hemoglobin levels in patients with invasive bladder cancer.
abstract: OBJECTIVE
  To determine whether pre-treatment hemoglobin (Hb) levels in patients with bladder cancer impact on oncological outcomes after radical cystectomy (RC).
  
  
  METHODS
  A consecutive, contemporary series of 246 patients undergoing RC and pelvic lymph node dissection for bladder cancer. Decreased Hb level was defined as ≤12 g/dL. The Kaplan-Meier method was used to estimate recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS). The Fisher exact/Chi-square test was used to investigate differences between both groups. Uni- and multivariable Cox regression analysis addressed risk factors for recurrence, cancer-specific death and overall death. The median follow-up was 30 months (2-116).
  
  
  RESULTS
  Of the 246 patients, 182 (74 %) had normal (>12 g/dL) and 64 decreased (≤12 g/dL) preoperative Hb (26 %). In univariable analysis, decreased Hb was associated with increased age, extravesical disease, hydronephrosis (all p < 0.001), node-positive disease and positive resection margins (both p = 0.01). Subanalyzed for patients with organ-confined disease (defined as ≤pT2bN0R0; N = 109), the 3-year RFS, CSS and OS was significantly lower in patients with decreased (34.9, 35.5 and 19.8 %) compared to normal Hb level (69.7, 86.3 and 77.6 %; p = 0.01/p = 0.002/p < 0.001). In multivariable analysis, RFS, CSS and OS were significantly lower in patients with decreased Hb (p = 0.007, p = 0.001 and p = 0.002), pathologically locally advanced tumor (≥pT3a; p = 0.023, p = 0.036 and p = 0.065) and nodal stage (p < 0.001, p = 0.006 and p = 0.001) and positive soft tissue surgical margins (p = 0.040, p = 0.004 and 0.012).
  
  
  CONCLUSIONS
  Pre-cystectomy Hb levels are associated with adverse histopathologic characteristics and provide additional prognostic information especially for patients with pathologically localized bladder cancer.
authors.affiliation: Department of Urology, Eberhard-Karls University Tuebingen, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany. Tinaschubert@gmx.net.
authors.forename: Tina
authors.initials: T
authors.lastname: Schubert
authors.affiliation: Department of Urology, Eberhard-Karls University Tuebingen, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Todenhöfer
authors.affiliation: Department of Urology, Eberhard-Karls University Tuebingen, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Mischinger
authors.affiliation: Department of Urology, Eberhard-Karls University Tuebingen, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
authors.affiliation: Department of Urology, Eberhard-Karls University Tuebingen, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Renninger
authors.affiliation: Department of Urology, Eberhard-Karls University Tuebingen, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.affiliation: Department of Urology, Eberhard-Karls University Tuebingen, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*
chemical_list: D006454:Hemoglobins
keywords: Bladder cancer; Hemoglobin; Radical cystectomy; Recurrence; Survival