Anemia in malignancies: Pathogenetic and diagnostic considerations

Gaspar, Balan Louis; Sharma, Prashant; Das, Reena

doi:10.1179/1607845414y.0000000161

Cited by 113 publications

(100 citation statements)

References 43 publications

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“…25,26 Low hemoglobin levels contribute to tumor hypoxia which is responsible for enhanced tumor growth; in addition, anemia can promote angiogenesis and genomic mutations in cells. 27 Serta et al 28 observed the level of hemoglobin was lower in patients with CRC compared to a control group. Several studies have demonstrated that preoperative hemoglobin levels were related to the prognosis of tumors, patients with pretreatment hemoglobin 12 g/dL, or less potentially yielding worse outcomes in breast cancer, 29 ovarian cancer, 30 and transitional cell carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of platelet‐lymphocyte ratio and hemoglobin‐platelet ratio in patients with rectal cancer

Qin

et al. 2020

Clinical Laboratory Analysis

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Background This study aimed to investigate the diagnostic value of platelet‐lymphocyte ratio (PLR) and hemoglobin‐platelet ratio (HPR) combined or not with carcinoembryonic antigen (CEA) in rectal cancer. Methods We recruited 235 patients pathologically diagnosed with rectal cancer, 113 patients with benign rectal diseases, and 229 healthy control patients in this retrospective analysis. Then, the correlation between PLR, HPR, and clinicopathological findings was analyzed. Receiver operating characteristic (ROC) curve was used to assess the diagnostic value of PLR and HPR combined or not with CEA in rectal cancer patients. Results The levels of PLR, HPR, and CEA were higher in rectal cancer patients than those in the subjects with benign rectal diseases (P < .001) and the healthy controls (P < .001). Platelet‐lymphocyte ratio and HPR were associated with lymph node metastasis and tumor stage, rather than serosa invasion, distant metastasis, or tumor size. PLR or HPR combined with CEA produced larger area under curve (AUC) (AUCPLR+CEA = 0.75, 95% CI = 0.70‐0.79, AUCHPR+CEA = 0.76, 95% CI = 0.71‐0.80) than PLR (P < .0001), HPR (P < .0001), or CEA (P = .024) alone. Conclusion Our results suggest that PLR or HPR combined with CEA can increase diagnostic efficacy and may be a useful diagnostic marker for patients with rectal cancer.

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Section: Discussionmentioning

confidence: 99%

Diagnostic value of platelet‐lymphocyte ratio and hemoglobin‐platelet ratio in patients with rectal cancer

Qin

et al. 2020

Clinical Laboratory Analysis

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“…Anemia is the most common "hematological complication, " found in ∼40-64% of patients with malignant diseases (94) and is mostly due to anemia of chronic disease (ACD) (284). ACD is caused by enhanced formation of pro-inflammatory cytokines, which can on the one hand directly inhibit erythropoiesis and on the other hand restrict the availability of iron for erythropoiesis.…”

Section: Immune Activation Causing Tryptophan Degradation and (Conseqmentioning

confidence: 99%

“…Apart from an activated immune system and enhanced Trp breakdown, patients with malignancies frequently suffer from anemia (94). Anemia is a main contributor to sustained fatigue (95), which is the most frequently reported symptom in cancer patients (96), affecting up to 78% (97).…”

Section: Introductionmentioning

confidence: 99%

Inflammation-Induced Tryptophan Breakdown is Related With Anemia, Fatigue, and Depression in Cancer

et al. 2020

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Many patients with cancer suffer from anemia, depression, and an impaired quality of life (QoL). These patients often also show decreased plasma tryptophan levels and increased kynurenine concentrations in parallel with elevated concentrations of Th1 type immune activation marker neopterin. In the course of anti-tumor immune response, the pro-inflammatory cytokine interferon gamma (IFN-γ) induces both, the enzyme indoleamine 2,3-dioxygenase (IDO) to degrade tryptophan and the enzyme GTP-cyclohydrolase I to form neopterin. High neopterin concentrations as well as an increased kynurenine to tryptophan ratio (Kyn/Trp) in the blood of cancer patients are predictive for a worse outcome. Inflammation-mediated tryptophan catabolism along the kynurenine pathway is related to fatigue and anemia as well as to depression and a decreased QoL in patients with solid tumors. In fact, enhanced tryptophan breakdown might greatly contribute to the development of anemia, fatigue, and depression in cancer patients. IDO activation and stimulation of the kynurenine pathway exert immune regulatory mechanisms, which may impair anti-tumor immune responses. In addition, tumor cells can degrade tryptophan to weaken immune responses directed against them. High IDO expression in the tumor tissue is associated with a poor prognosis of patients. The efficiency of IDO-inhibitors to inhibit cancer progression is currently tested in combination with established chemotherapies and with immune checkpoint inhibitors. Inflammation-mediated tryptophan catabolism and its possible influence on the development and persistence of anemia, fatigue, and depression in cancer patients are discussed.

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“…Bi et al [27] found that patients with high preoperative HGB levels and a high body mass index (BMI) had a good postoperative prognosis after RC, and one study showed that HGB was positively correlated with BMI [28]. Preoperative low hemoglobin levels can lead to tumor hypoxia, which promotes tumor growth by stimulating angiogenesis, acquiring genome mutations, and increasing resistance to apoptosis [13,29] and further leads to increased staging and a poor prognosis. On the other hand, it is speculated that tumor-related inflammation may result in the release of various inflammatory factors, which may affect erythropoietin synthesis and lead to the decrease in HGB [30].…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of routine preoperative blood parameters in muscle-invasive bladder cancer

et al. 2020

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Background:A routine blood examination is one of the most rapid, convenient and inexpensive clinical examinations that can reflect a patient's inflammatory status and other blood conditions, and the prognostic value of routine preoperative blood parameters in MIBC patients is still unclear, so we evaluated the prognostic value of routine preoperative blood parameters in muscle-invasive bladder cancer (MIBC) following radical cystectomy (RC).Methods: Data on 202 patients with MIBC who underwent RC at our institution were retrospectively collected between October 2007 and August 2018. The median preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and hemoglobin (HGB) values were used as cutoffs to form the low and high NLR, low and high PLR, and low and high HGB groups, respectively. The clinicopathologic characteristics of each group were compared by chi-square and t tests. Kaplan-Meier survival and multivariate Cox regression analyses were used to analyze prognosis.Results: The median NLR, PLR and HGB values were 2.42, 112 and 125 g/L, respectively. Kaplan-Meier results showed that the low HGB group had poor progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS). A high NLR and high PLR groups correlated only with poor OS. Multivariate Cox analyses showed that pathological T3/4 stage, positive lymph node status and low HGB were independent risk factors for PFS, CSS and OS, and age was the only independent risk factor for OS. Conclusion: Preoperative peripheral blood HGB is an independent risk factor for the prognosis of MIBC patients. These data suggest that HGB may be a useful prognostic marker for MIBC patients undergoing RC.

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Anemia in malignancies: Pathogenetic and diagnostic considerations

Cited by 113 publications

References 43 publications

Diagnostic value of platelet‐lymphocyte ratio and hemoglobin‐platelet ratio in patients with rectal cancer

Diagnostic value of platelet‐lymphocyte ratio and hemoglobin‐platelet ratio in patients with rectal cancer

Inflammation-Induced Tryptophan Breakdown is Related With Anemia, Fatigue, and Depression in Cancer

The prognostic value of routine preoperative blood parameters in muscle-invasive bladder cancer

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