Prognostic Value Of Preoperative Hemoglobin In Patients With Upper Tract Urothelial Carcinoma

Purpose: Anemia is the most common hematological abnormality in patients with cancer.Hemoglobin is one of the primary ways judge anemia.We evaluated the impact of preoperative hemoglobin on treatment outcome in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy.Methods: Clinical and pathologic data from 67 patients who underwent RNU for UTUC from 2008 to 2013 in Dalian Friendship Hospital urology were collected retrospectively.A total of 67 patients with upper tract urothelial carcinoma underwent radical nephroureterectomy. The following factors were included in the analysis:age,gender, preoperative hemoglobin, tumor site, side, tumor architecture,pathological stage,hydronephrosis, tumor necrosis.Preoperatively measured hemoglobin were stratified into normal and anemia based on the current standard classification of China:Hb < 12 g/dl and 11 considered anemia in males and females,respectively.Tumors were staged according to the 2009 Union for International Cancer Control on Cancer TNM classification.Histopathological assessment consisted of the presence of tumor architecture(papillary or sessile based on the predominant feature of the index lesion), tumor necrosis(microscopic coagulative necrosis in more than 10% of the tumor). Patients were generally followed every 3 to 4 months for the first 2 years after RNU, every 6 months from years 3 through 5 and annually thereafter. Followup consisted of history, physical examination, urinary cytology and cystoscopic evaluation of the bladder. CT of the abdomen and chest radiography were generally done semiannually or as clinically indicated. Additional imaging included bone or brain scan,chest CT or magnetic resonance imaging as clinically indicated.Disease recurrence was defined as tumor relapse in the operative field, regional lymph nodes and/or distant metastasis. Urothelial carcinoma in the bladder or contralateral upper tract was considered a metachronous tumor and not coded as disease recurrence.We used the chi-square test and Fisher exact to assess associations between categorical variables.The Kaplan-Meier method was used to calculate the recurrence-free survival rate(RFS).The difference of RFS curves between two groups was evaluated by Log-Rank test.Cox regression model were performed by multivariate analysis of risks factors.Forward-selection strategy was used to screen factors.Statistical tests wereperformed with SPSS 19.0.Results: 35 patients were male(52.2%) and 32 were female(47.8%).The med ian age was 74 years old.Median preoperative hemoglobin was 12.3g/dl(IQR 10.5,13.5).A total of 29 patients(43.3%) were anemic by the current standard of China.Anemia was associated with age(P=0.007) and pathological stage(P=0.015).At a median 45-month follow up anemia(P<0.001),pathological stage(P<0.001),tumor architecture(P<0.001) were associated with decreased recurrence-free survival on Kaplan-Meier analyses,respectively.3-year RFS was 80.6%.On multivariable ana lysis adjusted for standard clinicopathological factors preoperative hemoglobin(RR=1.968,95%CI:0.940-0.997,P=0.030),pathological stage(RR=3.183,95%CI:1.021-9.925,P=0.046),tumor architecture(RR=6.929,95%CI:1.318-36.425,P=0.022),remained an independent predictor of disease recurrence,respectively.Conclusions: Preoperative hemoglobin is an independent predictor of upper tract urothelial carcinoma recurrence. Hemoglobin is a promising marker for preoperative instructing and risk stratification for additional treatment decision making.Pathological stage and tumor architecture were also the independent predictors.