Abstract
The prognostic significance of preoperative anemia (PA) has been identified in various malignancies. However, its predictive role in urothelial carcinoma (UC) remains controversial. The aim of this study was to investigate the prognostic value of PA in UC patients. We performed a meta-analysis of the association between PA and survival outcome in UC patients. Electronic databases were searched up to June 30, 2016. Study characteristics and prognostic data were extracted from each included study. Cancer-specific survival (CSS), recurrence-free survival (RFS), and overall survival (OS) were pooled using hazard ratio (HR) with corresponding 95% confidence intervals (CI). Herein, 12 studies comprising 3815 patients were included in the meta-analysis. There were 1593 (41.76%) patients in the PA group and 2222 (58.24%) in the control group. The overall pooled HRs of PA for CSS, RFS, and OS were significant at 2.21, (95% CI: 1.83–2.65, Pheterogeneity = 0.49, I2 = 0%), 1.87 (95% CI: 1.59–2.20, Pheterogeneity = 0.22, I2 = 28%), and 2.04(95% CI: 1.76–2.37, Pheterogeneity = 0.36, I2 = 9%) respectively. Stratified analyses indicated that PA was a predictor of poor prognosis based on ethnicity, sample size, tumor T stage, G grade, lymphovascular invasion (LVI), concomitant carcinoma in situ (CIS), and follow-up values. Our findings show that PA has negative prognostic effects on the survival outcome (CSS, RFS, and OS) in UC patients and can serve as a useful and cost-effective marker to aid prognosis prediction.
Highlights
Urothelial carcinoma (UC), which derives from the transitional cells of the urinary tract, is the sixth most common cancer worldwide
It is well known that anemia can result in hypoxia in the tumor microenvironment, which may lead to instability and modification of hypoxia-induced genes such as VEGF, p53, and HIF-1 [34, 35]
Research has shown that the increased level of VEGF in tumor cells of preoperative anemia (PA) patients promotes angiogenesis, and tumor cells with p53 mutations may lose their apoptotic potential in hypoxic microenvironments [38,39,40]
Summary
Urothelial carcinoma (UC), which derives from the transitional cells of the urinary tract, is the sixth most common cancer worldwide. It accounts for more than 13,000 deaths annually [1]. Radical nephroureterectomy (RNU) with bladder cuff excision for upper tract urothelial cancer (UTUC), radical cystectomy (RC) with lymph node dissection for muscle-invasive bladder cancer (MIBC), and transurethral resection of bladder tumor (TURBT) for non-muscle invasive bladder cancer (NMIBC) constitute the standard treatment options for UC [2,3,4,5]. More than 20% of patients experience disease recurrence within 10 years of radical surgery [6,7,8]. The major pathologic determinants for survival in UC patients, such as tumor stage and surgical margin status, are well established. Tissue or blood-based biomarkers, which can act as prognostic predictors to improve the outcome of UC, have yet to be incorporated into daily clinical practice
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