Bladder Cancer Survival Predicted by Preop Hemoglobin, CRP

Hemoglobin (Hb) and C-reactive protein (CRP) levels prior to radical cystectomy for bladder cancer independently predict patients' disease-specific survival, Japanese researchers reported online in the International Journal of Urology.

In an analysis of data from 249 bladder cancer patients who underwent radical cystectomy without neoadjuvant therapy, Takehiro Sejima, MD, of Tottori University Faculty of Medicine in Yonago, and colleagues found that low hemoglobin levels (less than 10.5 g/L) and high CRP levels (greater than 0.5 mg/dL) independently predicted poor disease-specific survival (DSS), as did pT3a or greater disease stage and positive surgical margin (PSM).

Based on their findings Dr. Sejima's group created a risk stratification model to predict DSS. Each risk factor is assigned a value, and these values are added to arrive at a score. A hemoglobin level below 10.5 g/L, a CRP level above 0.5 mg/dL, and a disease stage of pT3a or higher each carries a value of 1. PSM has a value of 2. Thus, the maximum score is 5. Patients with a score of 0-1, 2, and 3-5 are classified as low, intermediate, and high risk. The four-year DSS in patients in the low-, intermediate-, and high-risk groups were 77.7%, 23.6%, and 7.4%, respectively.

The researchers stated that their report is the first to show the significance of combining preoperative Hb with the pathology of radical cystectomy specimens as an independent predictor for DSS. In addition, they noted, the study included the largest contemporary series to date demonstrating that two types of preoperative hematologic disorders, assessed by Hb and CRP, are independent predictors in bladder cancer patients treated with radical cystectomy.

“Our risk stratification model could provide physicians with useful prognostic information for identifying patients who might be candidates for multimodal treatments,” they concluded.

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