Prevalence and Prognostic Significance of Preoperative Anemia in Radical Cystectomy Patients: A Multicenter Retrospective Observational Study
Background and objective: Preoperative anemia is common in patients undergoing radical cystectomy for bladder cancer, but its prevalence and impact on outcomes remain poorly characterized across different health care settings. This study aims to assess the prevalence of preoperative anemia, evaluate...
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2025-07-01
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| author | Ernest Kaufmann Luca Antonelli Luca Afferi Vincenzo Asero Francesco Prata Silvia Rebuffo Alessandro Veccia Meftun Culpan Karl Tully Luis Ribeiro Thierry Roumeguere Kees Hendricksen Luca Lambertini Renate Pichler Nicola Pavan Jeremy Yuen-Chun Teoh Mathieu Roumiguié Gerald Bastian Schulz Francesco Soria Aamer AlGhamlas Pierre-Emmanuel Desprez Luca Orecchia Cedric Poyet Majed Alrumayyan Michael Rink Stefania Zamboni Maria Riaza Montes Steven Okoye Mattia Lo Re Wojciech Krajewski Luke Lavallee Marian Severin Wettstein Marco Moschini Christian Daniel Fankhauser |
| author_facet | Ernest Kaufmann Luca Antonelli Luca Afferi Vincenzo Asero Francesco Prata Silvia Rebuffo Alessandro Veccia Meftun Culpan Karl Tully Luis Ribeiro Thierry Roumeguere Kees Hendricksen Luca Lambertini Renate Pichler Nicola Pavan Jeremy Yuen-Chun Teoh Mathieu Roumiguié Gerald Bastian Schulz Francesco Soria Aamer AlGhamlas Pierre-Emmanuel Desprez Luca Orecchia Cedric Poyet Majed Alrumayyan Michael Rink Stefania Zamboni Maria Riaza Montes Steven Okoye Mattia Lo Re Wojciech Krajewski Luke Lavallee Marian Severin Wettstein Marco Moschini Christian Daniel Fankhauser |
| author_sort | Ernest Kaufmann |
| collection | DOAJ |
| description | Background and objective: Preoperative anemia is common in patients undergoing radical cystectomy for bladder cancer, but its prevalence and impact on outcomes remain poorly characterized across different health care settings. This study aims to assess the prevalence of preoperative anemia, evaluate its current management practices, and determine its association with postoperative and oncological outcomes in patients undergoing radical cystectomy. Methods: We retrospectively analyzed 4886 patients with nonmetastatic bladder cancer who underwent radical cystectomy across 28 centers in 13 countries. Multivariable regression models identified the predictors of preoperative hemoglobin levels and postoperative blood transfusions. Survival outcomes were assessed using Kaplan-Meier and Cox proportional hazards regression analyses. Key findings and limitations: Preoperative anemia was present in 44% of women and 48% of men. Among anemic patients, 73% received no blood management interventions. Higher hemoglobin levels before transurethral resection of a bladder tumor correlated with higher levels before cystectomy and fewer postoperative blood transfusions (odds ratio: 0.98, 95% confidence interval [CI]: 0.97–0.99, p < 0.001). Higher preoperative hemoglobin levels were associated with lower 90-d mortality rates (hazard ratio: 0.98, 95% CI: 0.97–0.99, p < 0.001) and independently predicted reduced all-cause mortality, cancer-specific mortality, and disease relapse. Conclusions and clinical implications: Preoperative anemia is prevalent and undertreated in patients undergoing radical cystectomy, and is independently associated with adverse perioperative and oncological outcomes. This highlights the need for further research regarding the potential benefits of implementing systematic preoperative anemia management. Patient summary: This study found that low blood counts before bladder removal surgery are common, often untreated, and linked to worse outcomes. Early treatment of low blood counts before surgery could improve results for patients. |
| format | Article |
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| publishDate | 2025-07-01 |
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| series | European Urology Open Science |
| spelling | doaj-art-ec65fbb6bb134cd68f9e18cd3c948da12025-07-17T04:44:59ZengElsevierEuropean Urology Open Science2666-16832025-07-01771018Prevalence and Prognostic Significance of Preoperative Anemia in Radical Cystectomy Patients: A Multicenter Retrospective Observational StudyErnest Kaufmann0Luca Antonelli1Luca Afferi2Vincenzo Asero3Francesco Prata4Silvia Rebuffo5Alessandro Veccia6Meftun Culpan7Karl Tully8Luis Ribeiro9Thierry Roumeguere10Kees Hendricksen11Luca Lambertini12Renate Pichler13Nicola Pavan14Jeremy Yuen-Chun Teoh15Mathieu Roumiguié16Gerald Bastian Schulz17Francesco Soria18Aamer AlGhamlas19Pierre-Emmanuel Desprez20Luca Orecchia21Cedric Poyet22Majed Alrumayyan23Michael Rink24Stefania Zamboni25Maria Riaza Montes26Steven Okoye27Mattia Lo Re28Wojciech Krajewski29Luke Lavallee30Marian Severin Wettstein31Marco Moschini32Christian Daniel Fankhauser33Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, SwitzerlandDepartment of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland; Department of Urology, Sapienza University of Rome, Rome, ItalyDepartment of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, SwitzerlandDepartment of Urology, Sapienza University of Rome, Rome, ItalyDepartment of Urology, Fondazione Policlinico Universitario Campus BIo-Medico of Rome, Rome, ItalyIRCCS Ospedale Policlinico S. Martino, Genoa, Italy; Department of Surgical and Diagnostic Integrated Sciences, University of Genoa, Genoa, ItalyDepartment of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyDepartment of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, TurkeyDepartment of Urology and Neurourology, Marien Hospital Herne, Ruhr University Bochum, Bochum, GermanySt. George’s University Hospital, London, UKService d’Urologie, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Bruxelles, BelgiumDepartment of urology, Netherlands Cancer Institute, Amsterdam, The NetherlandsUnit of Oncologic Minimally Invasive Urology and Andrology - Careggi Hospital, Department of Clinical and Experimental Medicine, University of Florence, Florence, ItalyDepartment of Urology, Medical University of Innsbruck, Innsbruck, AustriaUrology Clinic, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Palermo, ItalyS.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Urology, Medical University of Vienna, Vienna, AustriaDepartment of Urology, CHU-IUCT, Toulouse, FranceDepartment of Urology, LMU Munich, Munich, GermanyDivision of Urology, Department of Surgical Sciences, AOU città della Salute e della Scienza di Torino, Torino School of Medicine, Torino, ItalyUrology, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Sorbonne University, Paris, FranceUrology Department, Claude Huriez Hospital, CHU Lille, Lille, FranceUrology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, ItalyDepartment of Urology, Stadtspital Zürich Triemli, Zürich, SwitzerlandDivision of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, CanadaDepartment of Urology, Marienkrankenhaus Hamburg, Hamburg, GermanyUnit of Urology, Department of Medical and Surgical Specialities, Radiological Science and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, ItalyGaldakao-Usansolo Hospital, Vizcaya, SpainDepartment of Urology, Charité-Universitätsmedizin Berlin, Berlin, GermanyUnit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, ItalyDepartment of Minimally Invasive and Robotic Urology, Wrocław Medical University, Wrocław, PolandDivision of Urology, Department of Surgery, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, CanadaDepartment of Uro-Oncology, University of Toronto, Toronto, ON, CanadaDepartment of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele, Milan, ItalyDepartment of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland; Corresponding author. University of Lucerne, Lucerne, Switzerland. Tel. +41 44 255 11 11; Fax: +41 44 255 54 01.Background and objective: Preoperative anemia is common in patients undergoing radical cystectomy for bladder cancer, but its prevalence and impact on outcomes remain poorly characterized across different health care settings. This study aims to assess the prevalence of preoperative anemia, evaluate its current management practices, and determine its association with postoperative and oncological outcomes in patients undergoing radical cystectomy. Methods: We retrospectively analyzed 4886 patients with nonmetastatic bladder cancer who underwent radical cystectomy across 28 centers in 13 countries. Multivariable regression models identified the predictors of preoperative hemoglobin levels and postoperative blood transfusions. Survival outcomes were assessed using Kaplan-Meier and Cox proportional hazards regression analyses. Key findings and limitations: Preoperative anemia was present in 44% of women and 48% of men. Among anemic patients, 73% received no blood management interventions. Higher hemoglobin levels before transurethral resection of a bladder tumor correlated with higher levels before cystectomy and fewer postoperative blood transfusions (odds ratio: 0.98, 95% confidence interval [CI]: 0.97–0.99, p < 0.001). Higher preoperative hemoglobin levels were associated with lower 90-d mortality rates (hazard ratio: 0.98, 95% CI: 0.97–0.99, p < 0.001) and independently predicted reduced all-cause mortality, cancer-specific mortality, and disease relapse. Conclusions and clinical implications: Preoperative anemia is prevalent and undertreated in patients undergoing radical cystectomy, and is independently associated with adverse perioperative and oncological outcomes. This highlights the need for further research regarding the potential benefits of implementing systematic preoperative anemia management. Patient summary: This study found that low blood counts before bladder removal surgery are common, often untreated, and linked to worse outcomes. Early treatment of low blood counts before surgery could improve results for patients.http://www.sciencedirect.com/science/article/pii/S2666168325001235AnemiaBladder cancerHemoglobinPatient blood managementRadical cystectomySurvival outcomes |
| spellingShingle | Ernest Kaufmann Luca Antonelli Luca Afferi Vincenzo Asero Francesco Prata Silvia Rebuffo Alessandro Veccia Meftun Culpan Karl Tully Luis Ribeiro Thierry Roumeguere Kees Hendricksen Luca Lambertini Renate Pichler Nicola Pavan Jeremy Yuen-Chun Teoh Mathieu Roumiguié Gerald Bastian Schulz Francesco Soria Aamer AlGhamlas Pierre-Emmanuel Desprez Luca Orecchia Cedric Poyet Majed Alrumayyan Michael Rink Stefania Zamboni Maria Riaza Montes Steven Okoye Mattia Lo Re Wojciech Krajewski Luke Lavallee Marian Severin Wettstein Marco Moschini Christian Daniel Fankhauser Prevalence and Prognostic Significance of Preoperative Anemia in Radical Cystectomy Patients: A Multicenter Retrospective Observational Study European Urology Open Science Anemia Bladder cancer Hemoglobin Patient blood management Radical cystectomy Survival outcomes |
| title | Prevalence and Prognostic Significance of Preoperative Anemia in Radical Cystectomy Patients: A Multicenter Retrospective Observational Study |
| title_full | Prevalence and Prognostic Significance of Preoperative Anemia in Radical Cystectomy Patients: A Multicenter Retrospective Observational Study |
| title_fullStr | Prevalence and Prognostic Significance of Preoperative Anemia in Radical Cystectomy Patients: A Multicenter Retrospective Observational Study |
| title_full_unstemmed | Prevalence and Prognostic Significance of Preoperative Anemia in Radical Cystectomy Patients: A Multicenter Retrospective Observational Study |
| title_short | Prevalence and Prognostic Significance of Preoperative Anemia in Radical Cystectomy Patients: A Multicenter Retrospective Observational Study |
| title_sort | prevalence and prognostic significance of preoperative anemia in radical cystectomy patients a multicenter retrospective observational study |
| topic | Anemia Bladder cancer Hemoglobin Patient blood management Radical cystectomy Survival outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S2666168325001235 |
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