You have accessJournal of UrologyUrothelial Cancer: Upper Tract Tumors (II)1 Apr 2013898 PREOPERATIVE ANEMIA IS A POWERFUL PREDICTOR FOR POOR OUTCOMES IN UPPER TRACT UROTHELIAL CARCINOMA TREATED WITH RADICAL NEPHROURETERECTOMY Michael Rink, Hans-Martin Fritsche, Nasim Sharifi, Atiqullah Aziz, Bikheet Al-Matar, Jens Hansen, Luis A. Kluth, Wolfgang Otto, Florian Miller, Roland Dahlem, Arnulf Stenzl, Margit Fisch, and Georgios Gakis Michael RinkMichael Rink Hamburg, Germany More articles by this author , Hans-Martin FritscheHans-Martin Fritsche Regensburg, Germany More articles by this author , Nasim SharifiNasim Sharifi Hamburg, Germany More articles by this author , Atiqullah AzizAtiqullah Aziz Regensburg, Germany More articles by this author , Bikheet Al-MatarBikheet Al-Matar Tübingen, Germany More articles by this author , Jens HansenJens Hansen Hamburg, Germany More articles by this author , Luis A. KluthLuis A. Kluth Hamburg, Germany More articles by this author , Wolfgang OttoWolfgang Otto Regensburg, Germany More articles by this author , Florian MillerFlorian Miller Tübingen, Germany More articles by this author , Roland DahlemRoland Dahlem Hamburg, Germany More articles by this author , Arnulf StenzlArnulf Stenzl Tübingen, Germany More articles by this author , Margit FischMargit Fisch Hamburg, Germany More articles by this author , and Georgios GakisGeorgios Gakis Tübingen, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.471AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Preoperative anemia is a predictor for unfavorable outcomes in different urological malignancies including prostate, renal cell and bladder cancer. The impact of preoperative anemia in upper urinary tract carcinoma (UTUC) treated with radical nephroureterectomy (RNU) remains unclear. METHODS We collected data of 314 UTUC patients treated with RNU from 1990 û 2011 without neoadjuvant chemotherapy at three German academic institutions. Anemia was defined as a preoperative hemoglobin (Hb) level of ≤12g/dL according to the WHO classification. A sensitivity analysis was performed adjusting for gender variances (anemia definitions: male≤13g/dL, female≤12g/dL) according to more recent classifications (Beutler et al, Blood 2006). Uni- and multivariable Cox regression models analyzed the impact of anemia on disease recurrence and cancer-specific survival. RESULTS Eighty-eight (28%) UTUC patients had pre-RNU anemia according to WHO classification and 120 (38%) according to more recent classifications. Presence of pre-RNU anemia was associated with advanced tumor stage (p≤0.03), nodal metastasis (p≤0.04) and presence of LVI (p≤0.007) independent of the classification used. At a median follow-up of 31 months (IQR 14; 73) 103 (33%) and 79 (25%) patients experienced disease recurrence and died cancer-specific, respectively. Preoperative anemia was significantly associated with disease recurrence (p=0.01) and cancer-specific mortality (p≤0.017) on Kaplan-Meier analyses, respectively, with no difference in either anemia definition. In multivariable analyses that adjusted for pathologic stage and grade, nodal status, LVI, ureter margin status and adjuvant chemotherapy, preoperative anemia was an independent predictor for disease recurrence (WHO: HR 1.84, p=0.049; recent classifications: HR 2.36, p=0.003) and cancer-specific mortality when using recent classifications (HR 1.91, p=0.04). CONCLUSIONS Preoperative anemia in UTUC is highly associated with features of aggressive tumor biology, and an independent predictor for disease recurrence and cancer-specific mortality. Hb-levels are frequently available and easy to achieve prior to RNU, thus representing a promising marker for follow-up scheduling and maybe adjuvant therapies. Our findings need to be confirmed in larger RNU cohorts. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e371 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Rink Hamburg, Germany More articles by this author Hans-Martin Fritsche Regensburg, Germany More articles by this author Nasim Sharifi Hamburg, Germany More articles by this author Atiqullah Aziz Regensburg, Germany More articles by this author Bikheet Al-Matar Tübingen, Germany More articles by this author Jens Hansen Hamburg, Germany More articles by this author Luis A. Kluth Hamburg, Germany More articles by this author Wolfgang Otto Regensburg, Germany More articles by this author Florian Miller Tübingen, Germany More articles by this author Roland Dahlem Hamburg, Germany More articles by this author Arnulf Stenzl Tübingen, Germany More articles by this author Margit Fisch Hamburg, Germany More articles by this author Georgios Gakis Tübingen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...