The impact of anaemia on treatment outcome in patients with squamous cell carcinoma of anal canal and anal margin

Oblak, Irena; Češnjevar, Monika; Anzic, Mitja; Hadžić, Jasna But; Ermenc, Ajra Šečerov; Anderluh, Franc; Velenik, Vaneja; Jeromen, Ana; Korošec, Peter

doi:10.1515/raon-2015-0015

Cited by 18 publications

(19 citation statements)

References 44 publications

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“…Mature outcomes from the ACT-I trial supported evidence for palpable lymphnodes and male sex as prognostic factors for LRR and OS and interestingly, showed that lower baseline hemoglobin levels could predict for the risk of cancer-related death and death from any cause [ 11 ]. It is a common clinical observation that anemia is frequent in cancer patients [ 13 ]. This could substantially increase the proportion of hypoxic cancer cells, leading to an intrinsic resistance to radiotherapy (RT) and chemotherapy (CT), with potential detrimental effects on treatment outcomes [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…This could substantially increase the proportion of hypoxic cancer cells, leading to an intrinsic resistance to radiotherapy (RT) and chemotherapy (CT), with potential detrimental effects on treatment outcomes [ 14 ]. The impact of hemoglobin level in anal cancer patients submitted to CT-RT has been rarely reported [ 13 , 15 ]. In the present study, we intended to investigate the influence of different clinical prognostic factors, particularly baseline hemoglobin (Hb) levels, on treatment outcomes within a cohort of anal cancer patients submitted to combined RT and CT.…”

Section: Introductionmentioning

confidence: 99%

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The prognostic role of hemoglobin levels in patients undergoing concurrent chemo-radiation for anal cancer

et al. 2018

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BackgroundConcurrent chemo-radiation (CT-RT) is a standard therapy for squamous cell carcinoma of anal canal. Different clinical and biological factors may potentially affect outcome. We investigated the prognostic role of baseline hemoglobin (Hb) in a cohort of anal cancer patients submitted to CT-RT with 5-fluorouracil and mitomycin C.MethodsUp to 161 patients with clinical stage T1-T4/N0-N3/M0 were treated. Response was assessed at 6 weeks and thereafter at 3, 6 and 12 months. Two different approaches were used:a)simultaneous integrated boost following RTOG 05-29 indications;b)first sequence of 45Gy/25 fractions to the pelvis followed by 9–14.4 Gy/5–8 fractions to the macroscopic disease. Primary endpoints were progression-free survival (PFS) and overall survival (OS).ResultsOn multivariate analysis, pre-treatment Hb level had a significant correlation to OS (HR:0.53;95% CI:0.33–0.87; p = 0.001), but not to PFS (HR:0.78;95% CI:0.53–1.15; p = 0.12) Patients with pre-treatment Hb ≥ 12 g/dl had 5-year PFS and OS of 82.2%, compared to 29.3% and 32.8% for those below the threshold. The likelihood to achieve a complete remission increased by 5.6% for every single-unit (g/dl) increase in baseline Hb level over 11 g/dl. On multivariate analysis, response to treatment had a significant correlation to PFS (incomplete vs complete response – HR:5.43;95% CI:2.75–10.7; p < 0.0001) and OS (HR: 6.96;95% CI:2.96–16.5; p < 0.0001).ConclusionsWe showed that baseline Hb level is a strong indicator for poor response to RT-CT in anal cancer patients. A close clinical monitoring for incomplete response to treatment should be advised in patients with low pre-treatment Hb. The hypothesis that the preservation of adequate Hb level during treatment may lead to a better outcome needs prospective evaluation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The prognostic role of hemoglobin levels in patients undergoing concurrent chemo-radiation for anal cancer

et al. 2018

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“…Within the literature, the correlation between prechemoradiotherapy treatment anemia and poor treatment outcome has been widely discussed for other cancers, including lung, breast, cervix, and hematological malignancies [7]. Oblak et al [8] specifically examined the association between patients’ hemoglobin levels prior to commencement of chemoradiotherapy for squamous cell cancer of the anal canal and outcome of treatment. In that study of 100 patients, an hemoglobin >120 g/L was an independent prognostic indicator for survival, in keeping with established literature for other cancers.…”

Section: Discussionmentioning

confidence: 99%

Chemotherapeutic Response and Survival for Patients With an Anal Squamous Cell Carcinoma and Low Hemoglobin Levels

et al. 2018

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PurposeAnemia is associated with poor treatment results for a variety of cancers. The effect of low hemoglobin levels on long-term outcomes after the treatment of patients with an anal squamous cell carcinoma (SCC) remains unclear. For that reason, this study aimed to investigate the effect of anemia on treatment outcomes following chemoradiation for an anal SCC.Methods This was a retrospective study of all patients who underwent curative treatment for an anal SCC between 2009 and 2015 at 2 trusts in the United Kingdom. Data were collated from prospectively collected cancer databases and were cross-checked with operating-room records and records in the hospitals’ patient management systems.Results We identified 103 patients with a median age of 63 years (range, 36–84 years). The median overall survival was 39 months (range, 9–90 months), and the disease-free survival was 36 months (range, 2–90 months). During the follow-up period, 16.5% patients died and 13.6% patients developed recurrence. Twenty-two people were anemic prior to treatment, with a female preponderance (20 of 22). No differences in disease-free survival (P = 0.74) and overall survival (P = 0.12) were noted between patients with anemia and those with normal hemoglobin levels. On regression the analysis, the combination of anemia, the presence of a defunctioning colostomy, lymph-node involvement and higher tumor stage correlated with poor overall survival.Conclusion In this study, anemia did not influence disease-free survival or overall survival. We suggest that the interaction between anemia and survival is more complex than previously demonstrated and potentially reliant on other coexisting factors.

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“…For example, preoperative anemia has proved associated with poor prognosis in breast cancer [ 13 ]. The pre-treatment Hb level (cut-off 12 g/dL) was an independent prognostic factor for overall survival in anal canal cancer patients after radiation-chemotherapy [ 35 ]. Pretherapeutic Hb level as an independent useful marker for predicting pathologic tumor response in esophageal squamous cell carcinoma [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Hemoglobin level trajectories in the early treatment period are related with survival outcomes in patients with breast cancer

Lee

Tsai

Yeh³

et al. 2016

Oncotarget

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Hemoglobin (Hb) levels are reportedly related with treatment outcomes and survival in patients of breast cancer. However, the long-term change in Hb levels after treatment and the effects of Hb on survival remain unknown. This retrospective cohort study enrolled 1931 breast cancer patients with pathological stage I-IV between 1/1/2003 and 12/31/2013. Latent class modeling was used to identify trajectories in monthly Hb levels over time. The primary endpoint was 10-year cancer-related death. We identified 5 distinct Hb trajectories: persistent anemia (5.6 %; n = 109), improved anemia (4.8 %, n = 93), mild anemia (21.0%; n = 406), low normal Hb (46.6 %; n = 899), and normal Hb (21.9%; n = 424). Compared with the normal-Hb group, trajectories with low Hb levels had worst 10-year survival. The adjusted hazard ratios were 1.79(95% CI, 0.91-3.53) for the improved anemia group, 1.09(95% CI, 0.68-1.74) for the mild anemia group, 1.06 (95% CI, 0.71-1.60) for the low normal Hb group, and 2.19(95% CI 1.28-3.75) for the persistent anemia group. Our findings show there are five Hb level trajectories during breast cancer treatment. The anemia Hb level trajectory during the first 12 months after treatment reflect the worst cancer-related 10-year survival in breast cancer patients.

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The impact of anaemia on treatment outcome in patients with squamous cell carcinoma of anal canal and anal margin

Cited by 18 publications

References 44 publications

The prognostic role of hemoglobin levels in patients undergoing concurrent chemo-radiation for anal cancer

The prognostic role of hemoglobin levels in patients undergoing concurrent chemo-radiation for anal cancer

Chemotherapeutic Response and Survival for Patients With an Anal Squamous Cell Carcinoma and Low Hemoglobin Levels

Hemoglobin level trajectories in the early treatment period are related with survival outcomes in patients with breast cancer

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