Hemoglobin Level as a Prognostic Factor for Locally Advanced Bladder Cancer Patients Treated with Radical Radiotherapy

Main Article Content

Mohamed S. Zahi
Waleed N. Abozeed
Skoukri H. Elazab


Anemia is a common symptom in cancer patients and usually associated with poor prognosis. Urinary bladder cancer (BC) is the most common cancer in the urological tract with anemia being one the most common presenting symptom. Radical radiotherapy is the treatment of choice for advancer disease with many factors could influence the prognosis.

Aim: To identify pre-treatment hemoglobin level as prognostic factor for advanced bladder cancer treated with radiotherapy.

Materials and Methods: A retrospective study reviewed the data of 88 patients with advanced bladder cancer, treated with radical radiotherapy from 2013 to 2018.

Results: Median follow-up was 45 months. The median PFS was 26.87 months but when comparing anemic to non–anemic patient there was significant difference (17.25 and 40.02 months) respectively. Also as regards overall survival the median was 28.98 months but 20.24 and 40.47 months in anemic and non-anemic patients respectively with significant difference. Local or distant progression detected in 36 out of 50 anemic patients compared to only 4 out of 38 non-anemic patients. In multivariate analysis anemia was proved to be the strongest predictor of mortality.

Conclusion: Pre-treatment Hb level is an important factor affecting the prognosis of advanced bladder cancer patients treated with radical radiotherapy. Low HB level could be considered as a good biological marker for aggressive disease.

Bladder cancer, anemia, prognostic factors.

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How to Cite
Zahi, M. S., Abozeed, W. N., & Elazab, S. H. (2020). Hemoglobin Level as a Prognostic Factor for Locally Advanced Bladder Cancer Patients Treated with Radical Radiotherapy. Journal of Cancer and Tumor International, 10(2), 48-56. https://doi.org/10.9734/jcti/2020/v10i230126
Original Research Article


Ludwig H, Van Belle S, Barrett-Lee P, et al. The European Cancer Anaemia Survey (ECAS): A large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer. 2004;40:2293–306.

Straus DJ, Testa MA, Sarokhan BJ, et al. Quality-of-life and health benefits of early treatment of mild anemia: A randomized trial of epoetin alfa in patients receiving chemotherapy for hematologic malignancies. Cancer. 2006;107:1909–17.

Socinski MA, Zhang C, Herndon JE 2nd et al: Combined modality trials of the Cancer and Leukemia Group B in stage III non-small-cell lung cancer: Analysis of factors influencing survival and toxicity. Ann Oncol. 2004;15:1033–414.

Henry DH, Langer CJ, McKenzie RS et al: Hematologic outcomes and blood utilization in cancer patients with chemotherapy-induced anemia (CIA) pre- and post-national coverage determination (NCD): Results from a multicenter chart review. Support Care Cancer. 2012;20: 2089–96.

Ploeg M, Aben KK, Kiemeney LA: The present and future burden of urinary bladder cancer in the world. World J Urol. 2009;27:289–93.

Santacaterina A, Settineri N, De Renzis C, et al. Muscleinvasive bladder cancer in elderly-unfit patients with concomitant illness: can a curative radiation therapy be delivered? Tumori. 2002;88:390-4.

Milosevic M, Gospodarowicz M, Zietman A, et al. Radiotherapy for bladder cancer. Urology. 2007;69(1 Suppl):80- 92.

Vuslat Yurut-Caloglu1, Murat Caloglu1, Mustafa Kaplan2. Pre-treatment hemoglobin levels are important for bladder carcinoma patients with extravesical extension undergoing definitive radiotherapy Asian Pacific J Cancer Prev. 2009;10:1151-1158.

Bron D, Meuleman N, Mascaux C. Biological basis of anemia. Semin Oncol. 2001;28(2 Suppl 8):1-6.

Joynson CP, Sundar S, Symonds P. Anaemia is associated with poor overall survival but not with inferior local control in patients with muscle invasive bladder carcinoma treated by radical external beam radiotherapy. A retrospective study. Clin Oncol (R Coll Radiol). 2006;18:728-34.

Leilei Xia1, Thomas J. Guzzo2. Preoperative anemia and low hemoglobin level are associated with worse clinical outcomes in patients with bladder cancer undergoing radical cystectomy: A meta-analysis clin genitourin cancer. 2017;15 (2):263-272.e4.

Cheng Chen EF, Linkun Hu, Xiangxiang Li, et al. Preoperative anemia as a simple prognostic factor in patients with urinary bladder cancer. © Med Sci Monit. 2017; 23:3528-3535.

Block AM, Harkenrider MM, Henry E, et al. Concurrent chemotherapy improves overall survival in muscleinvasive bladder cancer patients undergoing radiation therapy: An analysis of the national cancer data base. Int. Journal. Rad. Onc. 2016;12: 213.