ArticleWorld journal of urology2026
Chemotherapy-induced anemia as a prognostic factor for overall survival in patients with bladder cancer treated with neoadjuvant cisplatin-based chemotherapy and cystectomy.
Article in World journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionPreoperative anemia (PA) and red blood cell transfusion (RBT) are associated with decreased survival in several cancers. In muscle-invasive bladder cancer (MIBC), anemia is frequent and may be worsened by neoadjuvant chemotherapy (NAC). While PA's impact is known in patients undergoing cystectomy without NAC, its prognostic value in the current multimodal approach remains unclear.
methodsWe retrospectively analyzed patients with cT2-T4 N0-N2 M0 MIBC treated with cisplatin-based NAC followed by radical cystectomy and lymphadenectomy between 2011 and 2022. We recorded the lowest hemoglobin value from NAC start to surgery (PA), use of RBT during NAC, and iron or vitamin B9/B12 supplementation.
resultsThis monocentric cohort included 175 patients (77% men, median age 65); 79% received dose-dense-MVAC, 75% had ≥ 4 cycles, median follow-up was 59 months. PA was present in 95%, with 58.2% having grade > 1. Among these, 50% received ≥ 1 transfusion, and 34.7% received supplementation. PA grade > 1 was significantly associated with worse OS (HR = 2.67, p = 0.006), RFS (HR = 2.00, p = 0.019), and SS (HR = 3.35, p = 0.003) versus PA grade 0-1. Other independent prognostic factors for OS included neutrophil count > 7 G/L (HR = 2.71, p = 0.010) and ypN+ (HR = 10.35, p < 0.001). RBT had no significant impact.
conclusionThis retrospective analysis demonstrated that PA grade > 1 negatively impacts overall survival, independent of other prognostic factors, in patients with MIBC treated with NAC. However, it remains necessary to determine whether - and how - optimizing hemoglobin levels before cystectomy could improve outcomes.
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