Hemoglobin, Albumin, Lymphocyte, and Platelet Count is a Significant Biomarker Surrogate for Nutritional Status to Predict Overall Survival in Patients Post–radical Cystectomy

No AccessUrology PracticePatient Care1 May 2023Hemoglobin, Albumin, Lymphocyte, and Platelet Count is a Significant Biomarker Surrogate for Nutritional Status to Predict Overall Survival in Patients Post–radical Cystectomy Christian M. Farag, Sinan Akosman, Jennica Luu, Shawn Haji-Momenian, and Michael J. Whalen Christian M. FaragChristian M. Farag *Correspondence: George Washington University School of Medicine, 2300 I St, NW, Washington, DC 20037 telephone: 317-287-9956; E-mail Address: [email protected] https://orcid.org/0000-0001-5640-6913 George Washington University School of Medicine, Washington, District of Columbia More articles by this author , Sinan AkosmanSinan Akosman https://orcid.org/0000-0003-3643-6570 George Washington University School of Medicine, Washington, District of Columbia More articles by this author , Jennica LuuJennica Luu https://orcid.org/0000-0002-3507-2683 George Washington University School of Medicine, Washington, District of Columbia More articles by this author , Shawn Haji-MomenianShawn Haji-Momenian https://orcid.org/0000-0002-6236-4956 George Washington University School of Medicine, Washington, District of Columbia Department of Radiology, George Washington University School of Medicine, Washington, District of Columbia More articles by this author , and Michael J. WhalenMichael J. Whalen https://orcid.org/0000-0002-2423-072X George Washington University School of Medicine, Washington, District of Columbia Department of Urology, George Washington University School of Medicine, Washington, District of Columbia More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000386AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Introduction: Nutritional status is an independent predictor of overall survival after radical cystectomy. Various biomarkers of nutritional status are proposed to predict postoperative outcome, including albumin, anemia, thrombocytopenia, and sarcopenia. Recently, a score comprising hemoglobin, albumin, lymphocyte, and platelet counts was postulated as an encompassing biomarker to predict overall survival post–radical cystectomy in a single-institution study. However, cutoffs for hemoglobin, albumin, lymphocyte, and platelet count are not well defined. In this study, we analyzed hemoglobin, albumin, lymphocyte, and platelet count thresholds predicting overall survival and examined the platelet-to-lymphocyte as an additional prognostic biomarker. Methods: Fifty radical cystectomy patients were retrospectively evaluated from 2010-2021. American Society of Anesthesiologists classification, pathological data, and survival were extracted from our institutional registry. Univariable and multivariable Cox regression analysis was fit to the data to predict overall survival. Results: Median follow-up was 22 (12-54) months. Hemoglobin, albumin, lymphocyte, and platelet count (continuous) was a significant predictor of overall survival on multivariable Cox regression analysis (HR 0.95, 95% CI: 0.90-0.99, P = .03), adjusting for Charlson Comorbidity Index, lymphadenopathy (pN >N0), muscle-invasive disease, and neoadjuvant chemotherapy. Optimal hemoglobin, albumin, lymphocyte, and platelet count cutoff was 25.0. Patients with hemoglobin, albumin, lymphocyte, and platelet count <25.0 had inferior overall survival (median, 33 months) vs with those with hemoglobin, albumin, lymphocyte, and platelet count ≥25.0 (median, not reached) (P = .03). Conclusions: Low hemoglobin, albumin, lymphocyte, and platelet count <25.0 was an independent predictor of inferior overall survival. References 1. . Bladder cancer: a review. JAMA. 2020; 324(19):1980-1991. Crossref, Medline, Google Scholar 2. . Radical cystectomy: a review of techniques, developments and controversies. Transl Androl Urol. 2020; 9(6):3073-3081. Crossref, Medline, Google Scholar 3. . Using preoperative albumin levels as a surrogate marker for outcomes after radical cystectomy for bladder cancer. Urology. 2013; 81(3):587-592. Crossref, Medline, Google Scholar 4. . Are patients at nutritional risk more prone to complications after major urological surgery?. 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Author Contributions: Conception and design: CMF, SH-M, MJW; Data analysis and interpretation: CMF, SA, JL, MJW; Critical revision of the manuscript for scientific and factual content: CMF, SA, JL, SH-M, MJW; Drafting the manuscript: CMF, SA; Statistical analysis: CMF, SA; Supervision: CMF, JL, SH-M, MJW. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 10Issue 3May 2023Page: 262-269 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Keywordsurinary bladder neoplasmscystectomybiomarkersnutritional statussurvivalMetrics Author Information Christian M. Farag George Washington University School of Medicine, Washington, District of Columbia *Correspondence: George Washington University School of Medicine, 2300 I St, NW, Washington, DC 20037 telephone: 317-287-9956; E-mail Address: [email protected] More articles by this author Sinan Akosman George Washington University School of Medicine, Washington, District of Columbia More articles by this author Jennica Luu George Washington University School of Medicine, Washington, District of Columbia More articles by this author Shawn Haji-Momenian George Washington University School of Medicine, Washington, District of Columbia Department of Radiology, George Washington University School of Medicine, Washington, District of Columbia More articles by this author Michael J. Whalen George Washington University School of Medicine, Washington, District of Columbia Department of Urology, George Washington University School of Medicine, Washington, District of Columbia More articles by this author Expand All Support: None. Conflict of Interest: The Authors have no conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. 041723). Author Contributions: Conception and design: CMF, SH-M, MJW; Data analysis and interpretation: CMF, SA, JL, MJW; Critical revision of the manuscript for scientific and factual content: CMF, SA, JL, SH-M, MJW; Drafting the manuscript: CMF, SA; Statistical analysis: CMF, SA; Supervision: CMF, JL, SH-M, MJW. Advertisement PDF downloadLoading ...