Post-diagnosis hemoglobin change associates with overall survival of multiple malignancies – results from a 14-year hospital-based cohort of lung, breast, colorectal, and liver cancers

Abstract

BackgroundAnemia refers to low hemoglobin (Hb) level and is a risk factor of cancer patient survival. The National Comprehensive Cancer Network recently suggested that post-diagnosis Hb change, regardless of baseline Hb level, indicates the potential presence of anemia. However, there is no epidemiological study evaluating whether Hb change has direct prognostic values for cancer patients at the population level.MethodsWe identified 6675 patients with a diagnosis of primary lung, breast, colorectal, or liver cancer who visited the Kimmel Cancer Center at the Thomas Jefferson University from 1998 to 2011. All patients had at least two Hb measurements within the first six months after diagnosis. We analyzed the main, dose-dependent, and time-dependent effects of Hb changes on patient survival.ResultsCompared to patients with a low Hb change (|∆Hb|≤2.6), those having a |∆Hb|>2.6 exhibited a significantly shorter survival (hazard ratio=1.40, 95% confidence interval 1.31-1.50, P=4.5 × 10-22, Plog rank=1.6 × 10-39). This association remained significant across the four cancer types. Bootstrap resampling validated these findings 100% of the time with P<0.01 in all patients and in patients of individual cancers. The association exhibited an apparent U-shape dose-dependent pattern. Time-dependent modeling demonstrated that the effect of Hb change on the survival of the overall patient population persisted for approximately 4.5 years after diagnosis.ConclusionPost-diagnosis Hb change associates with the survival of multiple cancers and may have clinical values in tailoring anti-anemia treatments. Because Hb level is frequently measured during cancer treatment, Hb changes may be a potentially important variable in building cancer prognosis models.

Prognostic value of routine laboratory variables in prediction of breast cancer recurrence

“…The scale of anemia may accord to the phase of breast cancer and the medication of chemotherapy 26 , 27 . Anemia, or HGB level, has been found to have strong relationship with recurrence and prognosis of breast cancer by the studies of ours and others 28 – 34 .…”

Alcohol consumption and survival after breast cancer diagnosis in Japanese women: A prospective patient cohort study

“…The association between alcohol consumption and the risk of breast cancer-specific death may be unclear in the standard Kaplan-Meier analysis [32]. Therefore, to further investigate this association, we attempted a bootstrap approach [32–34]. For example, the number of times with p<0.05 in 100 bootstrap random samples was 63 for the p-value (ever- vs. never-drinking) in Fig 1.…”

Cell-Cell Communication Networks Propose a Modulation of the Hematopoietic Stem Cell Niche by Invading Breast Carcinoma Cells

“…Furthermore, a high change of the hemoglobin level after diagnosis, which could in part represent impaired hematopoiesis, is associated with poor overall survival of breast cancer patients [72].…”