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

Abstract

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.

Evaluation of Hematological/Pathological Prognostic Factors and Oncological Outcomes of Patients with Locally Advanced Rectal Cancer Treated with Neoadjuvant Radiotherapy

“…In multivariate analysis, pre-treatment Hb level was significantly correlated with OS (p=0.001) but not with PFS (p=0.12). [29] In our study, similar results were obtained among all the hematological parameters, only pre RT Hb levels significantly correlated with OS but not with PFS. PFS and local control (LC) were significantly increased in patients with low pre-RT CEA.…”

“…As a result, the 5-year OS and DFS rates were 85% and 86% for patients with low CEA levels, 73% and 79% for patients with high CEA levels, respectively. [28] Franco et al [29] assessed the prognostic role of hemoglobin levels in 161 patients with anal cancer who underwent CRT. In multivariate analysis, pre-treatment Hb level was significantly correlated with OS (p=0.001) but not with PFS (p=0.12).…”

<p>Prognostic values of preoperative platelet-to-lymphocyte ratio, albumin and hemoglobin in patients with non-metastatic colon cancer</p>

“…Serum albumin is one of the most important indicators of nutritional status, and it is an independent prognostic indicator in various malignancies, such as gastric cancer,30 colorectal cancer,31 breast cancer,32 ovarian cancer33 and cervical cancer 34. Hemoglobin is a clinical characteristic that is a prognostic indicator in various malignancies, such as anal cancer35 and head and neck cancer 36,37. It was hypothesized that anaemia may enhance tumor hypoxia and increase tumor cell resistance to therapy to promote distant metastasis 35–37.…”

“…Hemoglobin is a clinical characteristic that is a prognostic indicator in various malignancies, such as anal cancer35 and head and neck cancer 36,37. It was hypothesized that anaemia may enhance tumor hypoxia and increase tumor cell resistance to therapy to promote distant metastasis 35–37. Franco et al reported that preoperative hemoglobin level was an independent prognostic indicator for OS, but not PFS 35.…”

Primary tumor size as a prognosticator in anal cancer patients

“…Mature data coming from the ACT-I trial suggested that palpable lymph nodes and male sex can be considered as prognostic factors for loco-regional recurrence and overall survival. The same trial and a confirmatory retrospective analysis showed that a low baseline hemoglobin level is able to predict for cancer-related death and death from any cause (5,7). The positivity to Human Papilloma Virus infection has also been shown to predict for overall and disease-specific survival (8).…”