Impact of hemoglobin level on survival in definitive chemoradiotherapy for T4/M1 lymph node esophageal cancer

Abstract

We retrospectively investigated the impact of the pre-chemoradiotherapy hemoglobin level (pre-CRT Hb level) for T4 and/or M1 lymph node (LYM) squamous cell carcinoma of the esophagus. Chemotherapy consisted of protracted infusion with 5-fluorouracil (5-FU) at 400 mg/m(2)/day on days 1-5 and 8-12, combined with cisplatin at 40 mg/m(2)/day on days 1 and 8, repeated twice at a 5-week interval. Concurrent radiation therapy was started on day 1 and delivered at 2 Gy/day for five days a week for a total radiation dose of 60 Gy, with a two-week break after a cumulative dose of 30 Gy. Several factors considered to be related with treatment outcome were evaluated by univariate and multivariate analysis. A total of 48 patients with T4/M1 LYM (lymphocyte) esophageal cancer treated with chemoradiotherapy (CRT) between September 2002 and April 2005 were enrolled. The complete response rate to this regimen was 44% and median survival time was 13.6 months, with a median follow-up period of 26.8 months. Median pre-CRT Hb level was 13.5 (10.4-15.3) g/dL. The CR rate in patients with a pre-CRT Hb level of 13 g/dL or less was only 24% but it was 60% in those with a level that was more than 13 g/dL (P=0.01). As for survival, anovarevealed that a pre-CRT Hb of 13 g/dL or less was a significant prognostic factor with a hazard ratio of 0.45 (95% confidence interval [CI]); 0.21-0.97, P=0.04), while on manova, including performance status, tumor size, TNM stage and pre-CRT Hb level, a pre-CRT Hb level of 13 g/dL or less was the only significant prognostic factor, with a hazard ratio of 0.35 (95% CI; 0.13-0.90, P=0.03). In conclusion, the pre-CRT Hb level may be an important determinant of outcome in patients with T4/M1 LYM squamous cell carcinoma of the esophagus.

Combined prognostic value of pretreatment anemia and cervical node necrosis in patients with nasopharyngeal carcinoma receiving intensity‐modulated radiotherapy: A large‐scale retrospective study

“…The prognostic significance of low pretreatment anemia has previously been investigated in various cancers; low Hb is associated with poorer outcomes in many types of human cancer, particularly in HN cancers and gynecological tumors . A positive relationship between survival outcomes and Hb levels has been demonstrated in patients with NPC receiving RT ± chemotherapy: low pretreatment Hb was related to increased risk of death or metastasis .…”

A retrospective study: the prognostic value of anemia, smoking and drinking in esophageal squamous cell carcinoma with primary radiotherapy

“…In a multivariate analysis, anemia was identified as a highly significant prognostic factor for 2-year OS and 2-year DFS, independent of TNM stage and initial treatment. Zenda and colleagues [12] concluded that the pre-chemoradiotherapy hemoglobin level may be an important determinant of outcome in patients with T4/M1 LYM squamous cell carcinoma of the esophagus. This result was consistent with previous studies regarding anemia.…”

Anaemia is of prognostic significance in patients with oesophageal adenocarcinoma

“…These include a small study of 48 patients with T4/M1 SCC oesophageal cancer who were treated with chemoradiotherapy. 13 Pre-treatment haemoglobin of <13 g/dl was associated with a prognostic hazard ratio of 0.45 (p=0.04). A large study of 243 patients with SCC undergoing chemoradiotherapy found that 60 were anaemic and the five-year survival was significantly reduced in the anaemic group (p=0.001).…”