根治性膀胱切除术患者术前贫血的患病率及预后意义：一项多中心回顾性观察研究

IF 4.5 3区医学 Q1 UROLOGY & NEPHROLOGY

European Urology Open Science Pub Date : 2025-06-04 DOI:10.1016/j.euros.2025.05.002

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 , Christian Daniel Fankhauser

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引用次数: 0

摘要

背景和目的术前贫血在接受膀胱癌根治性膀胱切除术的患者中很常见，但其患病率和对预后的影响在不同的医疗机构中仍不清楚。本研究旨在评估根治性膀胱切除术患者术前贫血的患病率，评估其目前的管理做法，并确定其与术后和肿瘤预后的关系。方法回顾性分析13个国家28个中心4886例接受根治性膀胱切除术的非转移性膀胱癌患者。多变量回归模型确定了术前血红蛋白水平和术后输血的预测因子。采用Kaplan-Meier和Cox比例风险回归分析评估生存结果。主要发现和局限性：44%的女性和48%的男性存在手术后贫血。在贫血患者中，73%未接受血液管理干预。经尿道膀胱肿瘤切除术前较高的血红蛋白水平与膀胱切除术前较高的血红蛋白水平和术后输血较少相关(优势比：0.98,95%可信区间[CI]: 0.97-0.99, p <；0.001)。术前较高的血红蛋白水平与较低的90天死亡率相关(风险比：0.98,95% CI: 0.97-0.99, p <；0.001)，并独立预测全因死亡率、癌症特异性死亡率和疾病复发率的降低。结论和临床意义手术后贫血在根治性膀胱切除术患者中普遍存在且治疗不足，并且与不良的围手术期和肿瘤预后独立相关。这突出表明需要进一步研究实施系统性术前贫血管理的潜在益处。患者总结：本研究发现，膀胱切除手术前的低血球计数很常见，通常未经治疗，并与较差的结果有关。在手术前对低血球计数进行早期治疗可以改善患者的结果。

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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 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.

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