Various prognostic indicators, including clinico-pathological and pre-operative hematological factors to develop a novel prognostic factors-based risk stratification model for disease-specific survival (DSS) in bladder cancer (BCa) patients treated with radical cystectomy (RC) were investigated by a new study from Japan.
This large series demonstrated that two types of pre-operative haematological disorders assessed by haemoglobin (Hb) and C-reacted protein (CRP) are independent prognostic indicators for patients with BCa treated by RC.
"Despite the wealth of evidence on the oncological significance of various clinico-pathological and molecular parameters for survival in invasive BCa patients treated with radical cystectomy, alterations of pre-operative haematological parameters have not been sufficiently addressed," write the authors of the study.
In the course of the study, the researchers performed a retrospective analysis of 249 consecutive BCa patients treated with RC without neoadjuvant therapy at several institutions.
Prognostic value of the pre-operative hematological laboratory parameters along with patient's clinico-pathological parameters were evaluated by univariate and multivariate Cox proportional hazard model analyses. Based on these data, the scientists developed a new scoring model to predict DSS after RC using the regression coefficients of the multivariate model.
One-, 3-, and 5-year DSS rates were 89.1%, 69.3%, and 62.7%, respectively. In multivariate analysis, pre-operative values of low hemoglobin (Hb) (< 10g /dL) and high C-reacted protein (CRP) (> 0.5 mg / dL), pathological T stage (≥ pT3a), lympho-vascular invasion (LVI) and positive surgical margin (PSM) status were independent factors for predicting poor prognosis. The score was calculated as 2 (if PSM) + 2 (Hb < 10g /dL) + 1 (if ≥ pT3a) + 1 (if LVI) + 1 (CRP > 0.5 mg / dL) and 0 (if otherwise).
The 4-year DSS in patients with a score in the ranges 0-1 (low-risk), 2-3 (intermediate-risk) and 4-7 (high-risk) was 83.4%, 48.8% and 5.9%, respectively All differences in DSS between subgroups were P < 0.0001.