Pre-treatment Hemoglobin Levels are Important for Bladder Carcinoma Patients with Extravesical Extension undergoing Definitive Radiotherapy

Purpose: To evaluate prognostic factors affecting local control (LC), distant metastases-free survival (DMFS)and overall survival (OS) in bladder carcinoma patients undergoing extravesical extension. Patients and
Methods:We retrospectively reviewed the charts of 61 consecutive patients with T3 or T4 bladder carcinoma, treated withdefinitive radiotherapy from 1999 through 2007.
Results: Median age was 69 years and follow-up was 29 months.The LC rate was 33% at 4 years and was increased in patients with a Hb≥12 g/dl (p=0.003) or a LDH<180 U/L(p=0.021) and in those who received concurrent chemotherapy (p=0.022) on univariate analysis. DMFS wasaffected by anemia (Hb<12 g/dl) (p=0.039), the absence of chemotherapy (p=0.034) and the presence of newlydiagnoseddisease (p=0.01). The OS rate was 19% at 4 years. Non-pure transitional cell carcinoma histologicaltype (p=0.024), anemia (p=0.004), elevated LDH (p=0.003), and newly diagnosed disease (p=0.011) were poorprognostic factors on univariate analyses for OS. Anemia was the only negative prognostic factor for LC (p=0.03),DMFS (p=0.002) and OS (p<0.0001) on multivariate analysis.
Conclusion: Pre-treatment Hb level is the mostimportant prognostic factor in patients treated with definitive radiotherapy, so that anemia may act as a surrogatebiological marker for aggressive disease.