Prevalence and significance of anaemia in patients receiving long‐course neoadjuvant chemoradiotherapy for rectal carcinoma

BackgroundFew studies have investigated the relationship between anemia, smoking, drinking and survival in esophageal squamous cell carcinoma (ESCC) with primary radiotherapy. This study had the aim of evaluating the prognostic value of anemia, smoking and drinking in patients receiving primary radiotherapy for ESCC.MethodsA total of 79 patients who underwent radiotherapy during initial treatment for ESCC were included in this study. The 2-year overall survival (OS) and disease-free survival (DFS) were analyzed between the anemic and non-anemic groups, non-smokers and smokers, and non-drinkers and drinkers using the Kaplan-Meier method and the Cox proportional hazards model.ResultsThere were 79 patients (10 male) of median age 63 (range 38 to 84) years. The 2-year OS and DFS were 36% and 25%, respectively, in the non-anemic group, and 17% and 13%, respectively, in the anemic group (P = 0.019 for OS; P = 0.029 for DFS) using the Kaplan-Meier method. Survival analysis using the Kaplan-Meier method showed that the 2-year OS and DFS had no statistical difference between smoking, drinking and survival. In a univariate analysis, anemia was identified as a significant prognostic factor for 2-year OS (hazard ratio (HR) = 1.897; P = 0.024) and 2-year DFS (HR = 1.776; P = 0.036), independent of tumor, lymph node, metastasis (TNM) stage. In a multivariate analysis, anemia was identified as a highly significant prognostic factor for 2-year OS (HR = 2.125; P = 0.011) and 2-year DFS (HR = 1.898; P = 0.025), independent of TNM stage and initial treatment. We found no statistical difference in the 2-year OS and DFS associated with smoking (P > 0.2) and drinking (P > 0.6) using univariate and multivariate analysis.ConclusionsSmoking and drinking were not prognostic for 2-year OS or DFS. Anemia before radiotherapy was associated with poor prognosis and an increased risk of relapse, which may serve as a new prognostic characteristic in ESCC treated with primary radiotherapy. Hemoglobin is a routine examination and anemia is therefore simple and quick to determine.

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“…Similarly, Walter and colleagues [7] reported that the prevalence of anemia in rectal carcinoma with neoadjuvant radiotherapy was 35%.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2013

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“…Similarly, the prevalence of anemia was 35% in rectal carcinoma patients undergoing neoadjuvant radiotherapy, and 44% in advanced Ewing’s sarcoma patients undergoing chemotherapy [12,13]. …”

Section: Discussionmentioning

confidence: 99%

A retrospective study: the prevalence and prognostic value of anemia in patients undergoing radiotherapy for esophageal squamous cell carcinoma

et al. 2014

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BackgroundThe relationship between anemia and outcomes after radiotherapy has not been systematically addressed. The study aimed to assess the prevalence and prognostic value of anemia in patients receiving primary radiotherapy for esophageal squamous cell carcinoma (ESCC).MethodsA total of 103 patients with ESCC were retrospectively reviewed. Anemia was defined as a hemoglobin level <12 g/dl for men and <11 g/dl for women. The 3-year and 5-year overall survival (OS) and disease-free survival (DFS) were analyzed between the anemic and non-anemic groups using the Kaplan-Meier method and the Cox proportional hazards model.ResultsNo significant differences were observed in patient characteristics between the anemic and non-anemic groups. The prevalence of anemia was 29.1%. The 3-year and the 5-year OS were 43% and 37%, respectively, in the non-anemic group, and 20% and 17%, respectively, in the anemic group. The 3-year and the 5-year DFS were 37% and 26%, respectively, in the non-anemic group, and 13% and 10%, respectively, in the anemic group. Survival analysis using the Kaplan-Meier method showed that there was significant difference between anemia and non-anemia (P < 0.02). In a multivariate analysis, anemia was identified as a highly significant prognostic factor for 3-year OS (hazard ratio 1.916; P = 0.012) and 3-year DFS (hazard ratio 1.973; P = 0.007), independent of T stage and the status of lymph nodes, and 5-year OS (hazard ratio 1.705; P = 0.027) and 5-year DFS (hazard ratio 1.980; P = 0.005), independent of TNM stage and the status of lymph nodes.ConclusionsAnemia before primary radiotherapy was associated with poor prognosis and an increased risk of relapse, which may serve as a new prognostic factor for ESCC.

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“…The evidence base for the association of pre‐treatment haemoglobin and response to chemoradiotherapy is well established in the oncology literature for a variety of cancers, including those of the head and neck, the uterine cervix, the oesophagus and the anal canal. It is perhaps less well recognized in rectal cancer , as demonstrated by a further contribution in this issue of Colorectal Disease by Khan et al . .…”

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confidence: 99%

“…. Postulated to occur via a mechanism of diminished tissue oxygenation, it appears that the presence of even subtle degrees of anaemia can lead to a diminished local response to chemoradiotherapy when given for rectal cancer and a worse oncological outcome compared with patients with a pre‐treatment haemoglobin in the normal range . This appears to be an association rather than a causal link, with no controlled studies having been done in which the response to chemoradiotherapy has been studied in rectal cancer patients with corrected anaemia.…”

mentioning

confidence: 99%

“…The evidence base for the association of pre-treatment haemoglobin and response to chemoradiotherapy is well established in the oncology literature for a variety of cancers, including those of the head and neck, the uterine cervix, the oesophagus and the anal canal. It is perhaps less well recognized in rectal cancer [5][6][7][8][9], as demonstrated by a further contribution in this issue of Colorectal Disease by Khan et al [10]. Postulated to occur via a mechanism of diminished tissue oxygenation, it appears that the presence of even subtle degrees of anaemia can lead to a diminished local response to chemoradiotherapy when given for rectal cancer and a worse oncological outcome compared with patients with a pre-treatment haemoglobin in the normal range [5][6][7][8][9][10].…”

mentioning

confidence: 99%

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Predicting response to chemoradiotherapy in rectal cancer: are we there yet?

Lindsey

2013

Colorectal Disease

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Prevalence and significance of anaemia in patients receiving long‐course neoadjuvant chemoradiotherapy for rectal carcinoma

Abstract: The prevalence of anaemia in patients undergoing long-course neoadjuvant radiotherapy was 35%. Anaemia during long-course neoadjuvant radiotherapy was associated with significant reductions in tumour downstaging and regression.

Cited by 15 publications

References 26 publications

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

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

A retrospective study: the prevalence and prognostic value of anemia in patients undergoing radiotherapy for esophageal squamous cell carcinoma

Predicting response to chemoradiotherapy in rectal cancer: are we there yet?

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