Servicio de Urología, Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España.
Servicio de Urología, Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España.
Actas Urol Esp (Engl Ed). 2020 Sep;44(7):489-496. doi: 10.1016/j.acuro.2020.04.005. Epub 2020 Jun 26.
To evaluate the prevalence of preoperative anemia and its effect on oncological outcomes in patients undergoing radical cystectomy (RC) due to bladder cancer.
Retrospective single-center study with 176 RCs between May 2008 and July 2018. Anemia was defined according to the WHO classification (male<130mg/dL, female<120mg/dL). Kaplan-Meier test was used to estimate recurrence-free, cancer-specific and overall survival rates. Multivariate logistic regression was used to identify factors associated with overall mortality rates.
Overall, 89 (50.6%) patients had preoperative anemia, and 44 of them (49.4%) received neoadjuvant chemotherapy. Anemic patients resulted in higher rates of ASA (ASA>2: 54.6 vs. 27.5%; P=.003), ectasia rate previous to RC (41.6 vs. 19.5%; P=.002), treatment with neoadjuvant chemotherapy (49.4 vs. 19.5%; P<.001), blood transfusion rate (25.8 vs. 11.5%; P=.015) and pathological stage (pT>2: 49.4 vs. 33.3%; P=.03) compared to non-anemic patients. Median follow-up was 27.2 months (IQR 11.12-72.28). Median overall survival (105 vs. 34 months, log-rank; P=.001), cancer-specific survival (89 vs. 61 months; P=.004) and recurrence-free survival (85 vs. 57 months; P=.002) were significantly lower in anemic patients compared to the non-anemic group. In multivariable Cox analysis, preoperative anemia, pT>2 and N≥1 were independently associated with overall mortality.
Preoperative anemia was common in patients undergoing RC for bladder cancer, and it is related with a worse cancer prognosis. Anemia is a preoperative modifiable factor; we believe that the implementation of Patient Blood Management programs during prehabilitation may have a relevant role in improving the oncological outcomes in these patients.
评估膀胱癌根治性切除术（RC）患者术前贫血的发生率及其对肿瘤学结局的影响。
这是一项回顾性单中心研究，共纳入了 2008 年 5 月至 2018 年 7 月期间 176 例接受 RC 的患者。贫血根据世界卫生组织（WHO）分类定义（男性<130mg/dL，女性<120mg/dL）。采用 Kaplan-Meier 检验估计无复发生存率、癌症特异性生存率和总生存率。采用多变量 logistic 回归分析识别与总死亡率相关的因素。
总体而言，89 例（50.6%）患者术前存在贫血，其中 44 例（49.4%）接受了新辅助化疗。与非贫血患者相比，贫血患者的美国麻醉医师协会（ASA）分级更高（ASA>2：54.6% vs. 27.5%；P=.003），RC 前扩张率更高（41.6% vs. 19.5%；P=.002），接受新辅助化疗的比例更高（49.4% vs. 19.5%；P<.001），输血率更高（25.8% vs. 11.5%；P=.015），病理分期更高（pT>2：49.4% vs. 33.3%；P=.03）。中位随访时间为 27.2 个月（IQR 11.12-72.28）。与非贫血患者相比，贫血患者的总生存（105 个月 vs. 34 个月，log-rank；P=.001）、癌症特异性生存（89 个月 vs. 61 个月；P=.004）和无复发生存（85 个月 vs. 57 个月；P=.002）显著降低。多变量 Cox 分析显示，术前贫血、pT>2 和 N≥1 与总死亡率独立相关。
膀胱癌根治性切除术患者术前贫血较为常见，且与癌症预后较差相关。贫血是术前可改变的因素；我们认为，在预康复期间实施患者血液管理方案可能对改善这些患者的肿瘤学结局具有重要作用。
