Baseline hemoglobin <11.0 g/dL has stronger prognostic value than anemia status in nasopharynx cancers treated with chemoradiotherapy

Abstract

Background: To retrospectively investigate the influence of pretreatment anemia and hemoglobin levels on the survival of nasopharyngeal carcinoma patients treated with concurrent chemoradiotherapy (C-CRT). Methods: A total of 149 nasopharyngeal carcinoma patients who received C-CRT were included. All patients had received 70 Gy to the primary tumor plus the involved lymph nodes, and 59.4 Gy and 54 Gy to the intermediate- and low-risk neck regions concurrent with 1–3 cycles of cisplatin. Patients were dichotomized into non-anemic and anemic (hemoglobin &lt;12 g/dL (women) or &lt;13 g/dL (men)) groups according to their pre-treatment hemoglobin measures. Receiver operating characteristic (ROC) curve analysis was utilized for accessibility of a pre-treatment hemoglobin cut-off that impacts outcomes. Potential interactions between baseline anemia status and hemoglobin measures and overall survival, locoregional progression-free survival (LRPFS), and progression-free survival were assessed. Results: Anemia was evident in 36 patients (24.1%), which was related to significantly shorter overall survival ( P=0.007), LRPFS ( P&lt;0.021), and progression-free survival ( P=0.003) times; all three endpoints retained significance in multivariate analyses ( P&lt;0.05, for each). A baseline hemoglobin value of 11.0 g/dL exhibited significant association with outcomes in ROC curve analysis: hemoglobin &lt;11.0 g/dL (N=26) was linked with shorter median overall survival ( P&lt;0.001), LRPFS ( P=0.004), and progression-free survival ( P&lt;0.001) times, which also retained significance for all three endpoints in multivariate analyses and suggested a stronger prognostic worth for the hemoglobin &lt;11.0 g/dL cut-off value than the anemia status. Conclusion: Pre-C-CRT hemoglobin &lt;11.0 g/dL has a stronger prognostic worth than the anemia status with regard to LRPFS, progression-free survival, and overall survival for nasopharyngeal carcinoma patients.

High Pretreatment Platelet-to-Albumin Ratio Predicts Poor Survival Results in Locally Advanced Nasopharyngeal Cancers Treated with Chemoradiotherapy

“…47 In support, depressed ALB levels were shown to be connected with dismal prognoses in many cancers including the NPCs. 22,26,[48][49][50] Moreover, as aforementioned, a recently published meta-analysis comprising 7339 NPCs from 10 studies showed that lower pre-treatment 31 Therefore, although further research may provide valuable insights into the exact relationship between a high PAR and diminished survival results, the present and the above-mentioned results altogether suggest convenient usefulness for the novel PAR in the prognostic stratification of LANPC patients treated with definitive CCRT. Chief strengths of our present investigation are as follows: First, head and neck MRI and PET-CT constituted the standard initial staging procedures for each qualified patient, as both were found to increase the staging accuracy of NPCs in terms of exclusion of second primary cancers; T, N, and M staging; target volume delineation; response, and toxicity evaluations; as well as the prognostic stratification of patients.…”

Baseline Low Prognostic Nutritional Index Predicts Poor Survival in Locally Advanced Nasopharyngeal Carcinomas Treated With Radical Concurrent Chemoradiotherapy

“…All patients received definitive CCRT with the RT and chemotherapy doses as reported previously. 24 In brief, the RT technique was 3-dimensional conformal RT (3D-CRT) between January 2007 to June 2011 and IMRT thereafter, administered in a daily fractionation basis: 5 days/week, for 7 weeks. Anti-emetic and nutritional support was provided as indicated.…”

Pretreatment Photopenia on 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Scans Predicts Poor Prognosis in Nasopharyngeal Cancer Patients Undergoing Concurrent Chemoradiotherapy

“…Supporting the “O 2 fixation hypothesis” which proposes that the radiation-induced DNA lesions will less likely be permanent in the hypoxic regions, Nordsmark and Overgaard [ 24 ] showed that the proportion of pO2 values <2.5 mmHg was independently associated with LRF rates [ 24 ]. Similarly, we recently demonstrated that pre–C-CRT hemoglobin <11.0 g/dL (another surrogate marker of hypoxia), had a stronger prognostic worth than the anemia status respecting the LRF rates and LRPFS durations for NPC patients [ 5 ]. In another study, Lin et al [ 18 ] examined the pretreatment CT and PET/CT of 91 pharyngeal cancers treated with definitive RT/C-CRT, and distinguished the CNN (hazard ratio [HR], 10.99) and N-TLG40% (40% of the maximal uptake of nodal TLG) ≥38 g (HR, 2.63) as the two independent adverse risk factors for nodal relapse-free survival.…”

“…Clinically; our present significantly higher actuarial 5-year DM rate (34.5% vs. 16.0%, P=0.002) in the PP+ cohort appears to confirm this preclinical evidence. Clinically, underscoring the prognostic importance of hypoxia in NPC patients, recently it was reported that the pre-C-CRT hemoglobin <11.0 g/dL had a stronger prognostic worth than the anemia status with regards to the LRPFS (P=0.004), PFS (P=0.004), and OS (P=0.004) [ 5 ]. Furthermore, the DMFS was shown to be significantly affected between the all CNN grades in the Zhang’s aforementioned study [ 23 ], bringing the contention that even minimum hypoxic necrosis (grade 1) seems to be not clinically different from more hypoxic necrosis such as grade 2 in terms of DMFS, as an “all or none phenomenon”.…”

“…As previously described elsewhere [ 5 ], all patients received definitive C-CRT, via three-dimensional conformal RT between January 2007 to June 2011 and intensity-modulated RT (IMRT), afterwards. All RT was prescribed in a daily fractionation basis: 5 day/wk, for 7 weeks.…”