Abstract
Background and objectiveNeoadjuvant chemotherapy (NAC) can be associated with anemia, which can lead to more perioperative blood transfusions (PBT). Usage of PBT is associated with worse oncological outcomes. We evaluated the prevalence of preoperative anemia (PA) and the effect on hemoglobin levels depending on surgery timing after NAC.MethodsA retrospective single-center study with 240 consecutive patients undergoing radical cystectomy (RC) between 2001 and 2014 for muscle-invasive urothelial carcinoma (MIBC). Anemia was defined according to the WHO classification (male ≤ 130 g/L, female ≤ 120 g/L). Multivariable logistical regression was used to identify factors associated with PA and Pearson correlation for evaluating the change in hemoglobin levels depending on surgery timing.ResultsOverall, 128 (53.3 %) patients were anemic pre-RC and 87 (36.3 %) patients received NAC. In a multivariable analysis, age, receipt of NAC, female gender, and low BMI were independent predictors of PA. In patients receiving NAC, the time to surgery from the last NAC cycle was correlated with the change in hemoglobin levels between the initiation of NAC and surgery.ConclusionsPA was common in patients undergoing RC for MIBC. Receipt of NAC was found to be a strong predictor of PA.Clinical messageThe emerging treatment of cisplatin based neoadjuvant chemotherapy for muscle-invasive bladder cancer, confers an increased risk for preoperative anemia. In the management of this malignancy, preoperative anemia renders further attention and focus.
Highlights
Background and objectiveNeoadjuvant chemotherapy (NAC) can be associated with anemia, which can lead to more perioperative blood transfusions (PBT)
Univariable analyses showed that age (Odds Ratio [OR] 1.046; p = 0.004), hydronephrosis, receipt of NAC and cT3 or cT4 stage, both compared to cT2 were associated with preoperative anemia (PA)
PA increases the risk for usage of PBT, and we found it of importance to investigate effects of NAC on PA
Summary
Background and objectiveNeoadjuvant chemotherapy (NAC) can be associated with anemia, which can lead to more perioperative blood transfusions (PBT). The use of PBT have been shown to have a negative effect on prognosis in UBC (Abel et al 2014; Linder et al 2013; Gierth et al 2014; Morgan et al 2013). This detrimental effect has previously been shown in other cancer types; gastric, colorectal and hepatocellular carcinoma (Ojima et al 2009; Amato and Pescatori 2006; Wang et al 2009). We sought to evaluate the prevalence of PA, identify associated factors and evaluate the effect of NAC on hemoglobin (Hb) levels in patients with urothelial MIBC undergoing RC
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