Download is anemia a truly adverse prognostic factor of a chronic

IS ANEMIA A TRULY ADVERSE PROGNOSTIC FACTOR OF A CHRONIC KIDNEY DISEASE
PATIENT WITH UROTHELIAL CARCINOMA OF UPPER URINARY TRACT?
T.H. Lee1, Y.C. Hsieh2 , H.C Yah3, K.F. Yang1
1
Urology, Kaohsiung Medical university Chung-Ho Memorial Hospital, Taiwan
Department of Clinical Education and Training, Kaohsiung Medical University Chung-Ho Memorial Hospital,
Taiwan
3
Urology, Kaohsiung Municipal Ta-Tung Hospital, Taiwan
2
As previous published paper described, pre-op anemia is a adverse factor of prognosis for those with upper
urothelial carcinoma. The potential explanation is that anemia is caused by the inflammatory cytokine
secreted by the underlying malignancy. Thus, the worse the anemia is , the worse the prognosis is.
However, chronic kidney disease(CKD) also contributes to anemia due to insufficient serum erythropoietin.
Thus, here comes a question: does chronic kidney disease or urothelial carcinoma play a foremost role in
presenting anemia clinically.
We collected 377 patients with urothelial carcinoma receiving radical nephroureterectomy between 2000
and 2013. We defined preoperative anemia as hemoglobin less than 13 mg/dl and less than 12 mg/dl in
males and females according to WHO’s criteria. We also analysis the relationship between
anemia/CKD/recurrence free survival/cancer free survival. A meaningful statistics was derived; the anemia
of CKD stage 1~4 subgroup has an unpleasant influence on cancer specific survival. On the contrast, the
anemia of CKD stage 5 subgroup has no distinct influence on cancer specific survivial (P=0.007).
Preoperative anemia is viewed as an independent predictor of recurrence-free survival and cancer-specific
survival in upper tract urothelial carcinoma. Nevertheless, further analysis in the subgroup of CKD patients
with urothelial carcinoma revealed that hemoglobin is a valuable feature in CKD 1~4 subgroups, but not in
CKD 5 subgroup.