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Prognostic value of pretreatment inflammatory markers in variant histologies of the bladder: is inflammation linked to survival after radical cystectomy?

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Abstract

Purpose

To investigate differences in standard preoperative inflammatory markers in patients with urothelial carcinoma (UC) and variant histologies undergoing radical cystectomy (RC) and determine its impact on survival.

Methods

Patients undergoing RC at an academic high-volume center were retrospectively analyzed. Preoperatively taken CRP, leukocytes, hemoglobin (Hb), and thrombocytes were analyzed as routine inflammatory biomarkers. Log-rank tests and Kruskal–Wallis analysis were used to calculate for differences in survival and in blood levels of biomarkers.

Results

886 patients with complete follow-up and UC or variant histology underwent RC at our institution between 2004 and 2019. Although variant histology presents with significantly higher t stage than UC, cancer-specific survival (CSS) of UC (1-year-CSS: 93%) is not significantly different to variant histology of UC with squamous differentiation (UCSD, 1-year-CSS: 81%), squamous cell carcinoma (SCC, 1-year-CSS: 82%), and adenocarcinoma (AC, 1-year-CSS: 81%). In UC, alterations in all biomarkers except leukocytes beyond routine cut-off values were associated with poor survival (p < 0.01), whereas Hb beyond cut-off values are associated with poor prognosis in SCC (p < 0.05). CRP levels are significantly elevated in UCSD and SCC at time of surgery compared to UC (p < 0.05).

Conclusion

Inflammatory biomarkers reveal distinctive patterns across UC and variant histologies of bladder cancer. As inflammation might play an important role in cancer progression, further research is warranted to understand those molecular mechanisms and their potential therapeutic impact in variant histology of bladder cancer.

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Authors and Affiliations

  1. Department of Urology, Klinikum der Universität München, Munich, Germany

    Severin Rodler, Alexander Buchner, Lennert Eismann, Yannic Volz, Paulo Pfitzinger, Alexander Kretschmer, Gerald B. Schulz, Boris Schlenker, Christian G. Stief & Friedrich Jokisch

  2. Department of Pathology, Klinikum der Universität München, Munich, Germany

    Stephan T. Ledderose

  3. Department of Urology, Krankenhaus Barmherzige Brüder, Marchioninistraße 15, 81377, Munich, Germany

    Alexander Karl

Authors
  1. Severin Rodler
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  2. Alexander Buchner
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  3. Stephan T. Ledderose
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  4. Lennert Eismann
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  5. Yannic Volz
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  6. Paulo Pfitzinger
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  7. Alexander Kretschmer
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  8. Gerald B. Schulz
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  9. Alexander Karl
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  10. Boris Schlenker
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  11. Christian G. Stief
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  12. Friedrich Jokisch
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Contributions

Conceptualization: R, B, and J; methodology: B and J; formal analysis and investigation: R, B, L, and E; writing—original draft preparation: R, J; writing—review and editing: L, E, V, P, K, S, K, S, and S; supervision: R, S, K, and J.

Corresponding author

Correspondence to Severin Rodler.

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All research has been carried out in accordance with the World Medical Association Declaration of Helsinki (1964) and its later amendments and ethical standards of the institutional and national research committee. The institutional review board approved the study prior initiation (Reference number: 20–179).

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Rodler, S., Buchner, A., Ledderose, S.T. et al. Prognostic value of pretreatment inflammatory markers in variant histologies of the bladder: is inflammation linked to survival after radical cystectomy?. World J Urol 39, 2537–2543 (2021). https://doi.org/10.1007/s00345-020-03482-8

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  • DOI: https://doi.org/10.1007/s00345-020-03482-8

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