Prognostic impact of hemoglobin levels on treatment outcome in patients with nasopharyngeal carcinoma treated with sequential chemoradiotherapy or radiotherapy alone

Abstract

BACKGROUNDThe goal of the current study was to investigate the impact of hemoglobin (Hb) levels on treatment outcome in a randomized Phase III trial of patients with nasopharyngeal carcinoma (NPC) treated with induction chemotherapy followed by radiotherapy or with radiotherapy alone.METHODSBetween September 1989 and August 1993, 334 patients with advanced NPC were entered into a randomized trial comparing 3 cycles of induction chemotherapy (cisplatin and epirubicin) followed by radiotherapy with radiotherapy alone. Only evaluable patients who completed radiation were included in the analysis (n = 286). Patients were stratified into normal and low Hb groups according to baseline, preradiation, and midradiation Hb levels. Local recurrence–free, distant metastasis–free, and disease‐specific survival rates were estimated using the Kaplan–Meier method. Multivariate analysis was performed using the Cox model.RESULTSIn the chemotherapy arm, the mean baseline, preradiation, and midradiation Hb levels were 13.6, 11.0, and 11.8 g/dL, respectively. In the radiotherapy arm, the mean baseline/preradiation and midradiation Hb levels were 13.7 and 12.9 g/dL, respectively. A midradiation Hb level ≤ 11 g/dL was associated with significantly poorer 5‐year local recurrence–free (60% vs. 80%; P = 0.0059) and disease‐specific survival rates (51% vs. 68%; P = 0.001), with no difference in distant metastasis–free rates (69% vs. 67%; P = 0.83). No significant difference in treatment outcome according to baseline or preradiation Hb levels was noted. Multivariate analysis showed that a low midradiation Hb level, but not a low baseline or preradiation Hb level, was an independent predictor of local disease recurrence and malignancy‐related death.CONCLUSIONSThe current study showed that midradiation Hb level was an important prognostic factor with respect to local control and survival in patients with NPC. The high incidence of anemia after chemotherapy has a negative impact on treatment outcome, and this condition may reduce the benefit of induction chemotherapy. Attempts to correct anemia during radiation and the impact of anemia on treatment outcome requires further study. Cancer 2004. © 2004 American Cancer Society.

The effects of hemoglobin levels and their interactions with cigarette smoking on survival in nasopharyngeal carcinoma patients

“…The survival benefit of OS and FFS was mainly derived from improved regional tumor control, and post‐RT Hb level was not associated with distant failure. These results were consistent with those from previous studies . It is generally acknowledged that these findings are primarily a consequence of impaired tumor oxygenation or hypoxia, resulting in a more aggressive and radiotherapy‐resistant tumor phenotype .…”

“…Nasopharyngeal carcinoma (NPC) is a distinct form of HNSCC in terms of epidemiology, pathology, and response to treatment . Chua and his colleagues reported low mid‐radiation Hb levels to be an independent predictor of local disease recurrence in NPC patients , which is similar to the findings of previous studies on HNSCC. It is generally assumed that poor tumor control in patients with low Hb levels is primarily a consequence of tumor hypoxia .…”

“…Some studies have uncovered that low Hb levels prior to and during treatment have been associated with poor prognosis in HNSCC patients who were treated with radiotherapy; other studies have shown that post‐RT Hb level was associated with survival. Thus, the optimal time to measure Hb levels has never been established.…”

Radiomics Features of Multiparametric MRI as Novel Prognostic Factors in Advanced Nasopharyngeal Carcinoma

“…Therefore, radiomics signatures can have indispensable prognosis value totally complementary to clinical staging. Age, gender, body mass index, lactate dehydrogenase level in serum, hemoglobin, platelet counts, and various other prognostic factors have been identified and evaluated retrospectively in some previous studies (37)(38)(39). Therefore, we devised a clinical nomogram that combined available risk factors (age, gender, pretreatment hemoglobin, and platelet counts) with overall stage.…”

Long Term Outcomes and Prognostic Factors of N0Stage Nasopharyngeal Carcinoma: a Single Institutional Experience with 610 Patients

“…Anemia was indicated to be associated with the low local control rate and survival rate in the head and neck malignancies (Chua et al, 2004;Rades et al, 2008;. Low Hb levels led to tumor hypoxia, which was a well known factor contributing to decreased radiosensitivity and poor treatment outcomes.…”