Abstract
The outcome of bladder cancer after radical cystectomy is heterogeneous. We aim to evaluate the prognostic value of HALP (hemoglobin, albumin, lymphocyte and platelet) and explore novel prognostic indexes for patients with bladder cancer after radical cystectomy. In this retrospective study, 516 patients with bladder cancer after radical cystectomy were included. The median follow-up was 37 months (2 to 99 mo). Risk factors of decreased overall survival were older age, high TNM stage, high American Society of Anesthesiologists (ASA) grade and low HALP score. The predictive accuracy was better with HALP-based nomogram than TNM stage (C- index 0.76 ± 0.039 vs. 0.708 ± 0.041). By combining ASA grade and HALP, we created a novel index—HALPA score and found it an independent risk factor for decreased survival (HALPA score = 1, HR 1.624, 95% CI 1.139–2.314, P = 0.007; HALPA score = 2, HR 3.471, 95% CI: 1.861–6.472, P < 0.001).The present study identified the prognostic value of HALP and provided a novel index HALPA score for bladder cancer after radical cystectomy.
Highlights
Bladder cancer is the most common cancer in the urogenital system[1]
Hypoalbuminemia was present in 8.3% patients (n = 43; 3.9% with NMIBC, 11.1% with muscle-invasive bladder cancer (MIBC), P = 0.009) and anemia was present in 27.9% (n = 144; 12.4% with NMIBC, 37.5% with MIBC, P < 0.001)
Independent factors associated with decreased overall survival were older age, high TNM stage, high American Society of Anesthesiologists (ASA) grade and low HALP score (HR = 1.986, 95% confidence intervals (CIs): 1.386–2.886, P < 0.001) for bladder cancer patients after radical cystectomy (Table 3)
Summary
Bladder cancer is the most common cancer in the urogenital system[1]. In 2017, there were 79030 new cases estimated in United States; the cancer ranks 6th in all cancers and 4th in males[2]. Haematological parameters including leukocyte count (neutrophil, lymphocyte and monocyte), platelet count and levels of hemoglobin, albumin, C-reactive protein (CRP), and fibrinogen are all assessed and reliable indicators of postoperative prognosis[7,8,9,10,11]. The combination of those indices have better predictive ability, for example, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR)[12,13,14]. Characteristics Age, median (IQR) Gender female male Smoking history no yes Alcohol-drinking history no yes Hypertension no yes Histology subtype transitional cell carcinoma non-transitional cell carcinoma Grade 2 3 T-stage NMIBC MIBC N-stage negative positive M-stage negative positive Adjunctive chemotherapy yes no ASA grade 1&2 3&4 Anemia present absent Hypoalbuminemia present absent PLR, median (IQR) HALP, median (IQR)
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