Elderly Patients Affected by Glioblastoma Treated With Radiotherapy: The Role of Serum Hemoglobin Level

Fiorentino, Alba; Fusco, Vincenzo

doi:10.3109/00207454.2012.744309

Cited by 6 publications

(4 citation statements)

References 31 publications

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“…The finding that low hemoglobin level is significantly associated with a lower survival rate of GBM patients is consistent with the known fact that tendency toward anemia is linked to lower survival rates in cancer patients (23,25). In the context of GBM, several works supported low hemoglobin levels as a poor prognostic factor (16)(17)(18)(19)26), though other works were less supportive of this notion. Fiorentino and Fusco (26) studied the effect of hemoglobin level of mostly biopsied elderly GBM patients (median age of 71 years) and found that a hemoglobin level cutoff of ≥12 g/dL was not significantly related to overall survival but did show better progression-free survival.…”

Section: Discussionsupporting

confidence: 77%

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Hemoglobin Levels and Red Blood Cells Distribution Width Highlights Glioblastoma Patients Subgroup With Improved Median Overall Survival

et al. 2020

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Glioblastoma multiforme (GBM) is known for its dismal prognosis, though its dependence on patients' readily available RBCs parameters is not fully established. In this work, 170 GBM patients, diagnosed and treated in Soroka University Medical Center (SUMC) over the last 12 years were retrospectively inspected for their survival dependency on pre-operative RBCs parameters. Besides KPS and tumor resection supplemented by oncological treatment, age under 70 (HR = 0.4, 95% CI 0.24-0.65, p = 0.00073), low hemoglobin level (HR = 1.79, 95% CI 1.06-2.99, p = 0.031), and Red Cell Distribution Width (RDW) <14% (HR = 0.57, 95% CI 0.37-0.88, p = 0.018) were found to be prognostic of patients' overall survival in multivariate analysis, accounting for a false discovery rate of < 5% due to multiple hypothesis testing. According to these results, a stratification tree was made, from which a favorable route highlighted a subgroup of nearly 30% of the cohorts' patients whose median overall survival was 21.1 months (95% CI 16.2-27.2)-higher than the established chemo-radiation standard first-line treatment regimen overall median survival average of about 15 months. The beneficial or detrimental effect of RBCs parameters on GBM prognosis and its possible causes is discussed. Keywords: glioblastoma multiforme (GBM), hemoglobin, RDW (red cell distribution width), prognostic factors, overall survival KEY POINTS-GBM resection followed by oncological treatment of patients under the age of 70 with normal hemoglobin level and RDW < 14% enhance patients' survival.-Measures aimed to normalize hemoglobin levels and RDW prior to surgical intervention may be useful in order to improve GBM patients' prognosis.

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Section: Discussionsupporting

confidence: 77%

“…This work was supported by subsequent works showing similar results (17,18). Nevertheless, some works failed to demonstrate the significant prognostic value of hemoglobin level for GBM (18,19,26). Another parameter recently studied is RDW, which reflects a degree of variation (anisocytosis) in the size of the circulating red cells.…”

Section: Introductionsupporting

confidence: 56%

Hemoglobin Levels and Red Blood Cells Distribution Width Highlights Glioblastoma Patients Subgroup With Improved Median Overall Survival

et al. 2020

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“…As shown in Table 2, pretreatment HGB, MCH, RBC, and HCT were not correlated with the OS of patients with GBM in our study. Similarly, a previous study showed that the HGB level did not influence clinical outcome in elderly patients with GBM [18]. However, Céfaro et al revealed that a low HGB level was associated with shorter OS in patients with high-grade gliomas [19].…”

Section: Discussionmentioning

confidence: 92%

Significance of Pretreatment Red Blood Cell Distribution Width in Patients with Newly Diagnosed Glioblastoma

Liang

Yang

et al. 2017

Med Sci Monit

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BackgroundRed blood cell distribution width (RDW) is a parameter of the complete blood count (CBC) test. Recent evidence suggests that pretreatment RDW is associated with patient survival in various malignant tumors. We explored the association of pretreatment RDW and other red blood cell (RBC) parameters with clinical parameters and assessed their prognostic impact on overall survival (OS) in patients with glioblastoma (GBM).Material/MethodsIn total, 109 patients with newly diagnosed GBM were retrospectively reviewed. The Cox proportional hazards regression model and Kaplan-Meier method were used to examine the survival function of pretreatment RDW, mean cell volume (MCV), hemoglobin (HGB), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), RBC count, and hematocrit (HCT) values in patients with newly diagnosed GBM.ResultsUnivariate analysis showed that MCV, MCHC, and RDW were associated with overall survival (OS). However, only RDW remained significant in multivariate analysis. The Kaplan-Meier survival curves showed that patients belonging to the high-RDW group had a worse median OS (293 days versus 375 days, P=0.023) than those belonging to the low-RDW group.ConclusionsThe present study showed that pretreatment RDW was superior to MCV and MCHC as a prognostic predictor of clinical outcome in patients newly diagnosed with GBM. Pretreatment RDW was derived directly from the CBC test, which can be easily performed in clinical practice. Therefore, pretreatment RDW values can provide additional prognostic information for patients with GBM. Further larger and prospective studies are needed to confirm these findings and to investigate the mechanism by which of RDW is associated with prognosis in patients with GBM.

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“…More recently (2020), Kismar-Elbaz et al [6] found that low hemoglobin levels (<12 g/dL [females] or <14 g/dL [males]) was a negative prognostic factor for survival, leading the authors to conclude that measures should be taken to normalize preoperative hemoglobin levels and red cell distribution width to improve prognosis. Notwithstanding the findings of those studies, other studies have not found any association between hemoglobin levels and prognosis in these patients [18,19]. In our previous study [17], we hypothesized that low levels of hemoglobin would increase HIF expression.…”

Section: Discussionmentioning

confidence: 76%

Prognostic Factors for Survival in Glioblastoma: A Retrospective Analysis Focused on the Role of Hemoglobin

Pleskacova,

Bartos,

Vosmikova

et al. 2024

Biomedicines

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Background: Although several prognostic factors for survival have been identified in glioblastoma, there are numerous other potential markers (such as hemoglobin) whose role has not yet been confirmed. The aim of this study was to evaluate a wide range of potential prognostic factors, including HIF-1α and hemoglobin levels, for survival in glioblastoma. A secondary aim was to determine whether hemoglobin levels were associated with HIF-1α expression. Methods: A retrospective study of 136 patients treated for glioblastoma at our institution between 2012 and 2021 was performed. Cox univariate and multivariate analyses were carried out. Kaplan–Meier survival curves were generated. In addition, bivariate non-parametric correlation analyses were performed for key variables. Results: Median survival was 11.9 months (range: 0–119.4). According to the univariate analysis, 13 variables were significantly associated with survival: age, performance status, extent of surgery, tumor depth, tumor size, epilepsy, postoperative chemoradiotherapy, IDH mutations, CD44, HIF-1α, HIF-1β, vimentin, and PDFGR. According to the multivariate regression analysis, only four variables remained significantly associated with survival: age, extent of surgery, epilepsy, and HIF-1α expression. No significant association was observed between hemoglobin levels (low <120 g/L in females or <140 g/L in males vs. high ≥120 or ≥140 g/L) and survival or HIF-1α/HIF-1β expression. Conclusions: In this retrospective study of patients with glioblastoma, four variables—age, extent of surgery, HIF-1α expression, and epilepsy—were significant prognostic factors for survival. Hemoglobin levels were not significantly associated with survival or HIF-1α expression. Although hypoxia is a well-recognized component of the glioblastoma microenvironment, more research is needed to understand the pathogenesis of onset tumor hypoxia and treatment implication.

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Elderly Patients Affected by Glioblastoma Treated With Radiotherapy: The Role of Serum Hemoglobin Level

Abstract: Our data suggested that extent of surgery and RPA class remain independent prognostic factor, whereas patients' anemia did not adversely affect prognosis in glioblastoma elderly patients.

Cited by 6 publications

References 31 publications

Hemoglobin Levels and Red Blood Cells Distribution Width Highlights Glioblastoma Patients Subgroup With Improved Median Overall Survival

Hemoglobin Levels and Red Blood Cells Distribution Width Highlights Glioblastoma Patients Subgroup With Improved Median Overall Survival

Significance of Pretreatment Red Blood Cell Distribution Width in Patients with Newly Diagnosed Glioblastoma

Prognostic Factors for Survival in Glioblastoma: A Retrospective Analysis Focused on the Role of Hemoglobin

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