The prognostic utility of hemoglobin and lymphocytopenia in bladder-sparing therapy.

Abstract

370 Background: Many patients with bladder cancer are found to have laboratory derrangements such as anemia and lymphocytopenia prior to treatment, though their prognostic value is unknown. We examined pretreatment lab values and clinical outcomes in patients with muscle-invasive bladder cancer (MIBC) who underwent bladder sparing trimodality therapy (TMT). Methods: We performed a retrospective analysis of 181 patients with T2-T4a bladder cancer who underwent TMT between 2001 and 2013. Pretreatment absolute lymphocyte count (ALC), neutrophil to lymphocyte ratio (NLR), and hemoglobin (Hgb) values were collected, and cut-off values were established to be 1.5*10^9/L, 3.12, and 12 g/dl, respectively. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were compared with Kaplan Meier survival probabilities and univariate and multivariate Cox regression analysis, controlling for gender, age, completeness of TURBT, response to TMT, cystectomy, clinical T stage, and hydronephrosis. Results: Median follow-up was 47 months. On univariate analysis, patients with a low pretreatment lymphocyte count had poorer OS (p = 0.03) than patients with a higher pretreatment lymphocyte count (5 year OS rates: 54% and 71%, respectively). Patients with pretreatment anemia had poorer OS (p = 0.001) and DSS (p < 0.001) than patients with a higher pretreatment hemoglobin count, (5 year OS rates: 39% and 65%; 5 year DSS rates: 39% and 72%, respectively). On multivariate analysis, pretreatment anemia was significantly associated with poorer OS (HR 2.58, 95% CI 1.36–4.90) and DSS (HR 3.23, 95% CI 1.62–6.43), whereas complete response to TMT was significantly associated with improved OS (HR 0.24, 95% CI 0.13–0.43) and DSS (HR 0.29, 95% CI 0.14–0.59). Complete response to TMT was significantly associated with improved DFS (HR 0.36, 95% CI 0.21–0.61), and a higher clinical T stage was associated with poorer DFS (HR 2.38, 95% CI 1.19–4.75). Conclusions: When adjusting for clinical factors, pretreatment anemia remained an independent predictor of overall and disease-specific survival following TMT. Further prospective validation of lab values and clinical outcomes in MIBC are needed.