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

다국어 초록 (Multilingual Abstract)

Purpose: Anemia 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.

참고문헌 (Reference)

1 Mhaskar R, "The role of iron in the management of chemotherapy-induced anemia in cancer patients receiving erythropoiesis-stimulating agents" 2 : 2016

2 Banerjee R, "The prognostic significance of pretreatment leukocytosis in patients with anal cancer treated with radical chemoradiotherapy or radiotherapy" 56 : 1036-1042, 2013

3 Oblak I, "The impact of anaemia on treatment outcome in patients with squamous cell carcinoma of anal canal and anal margin" 50 : 113-120, 2016

4 Ludwig H, "The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients" 40 : 2293-2306, 2004

5 Kitano T, "Prevalence and incidence of anemia in Japanese cancer patients receiving outpatient chemotherapy" 86 : 37-41, 2007

6 Naoum FA, "Iron deficiency in cancer patients" 38 : 325-330, 2016

7 Barrett-Lee PJ, "Independent risk factors for anemia in cancer patients receiving chemotherapy: results from the European Cancer Anaemia Survey" 70 : 34-48, 2006

8 American Joint Committee on Cancer, "Implementation of AJCC 8th Edition Cancer Staging System [Internet]" American Joint Committee on Cancer

9 Harrison LB, "Impact of tumor hypoxia and anemia on radiation therapy outcomes" 7 : 492-508, 2002

10 Nigro ND, "Combined therapy for cancer of the anal canal: a preliminary report" 17 : 354-356, 1974

11 Steinmetz T, "Clinical experience with ferric carboxymaltose in the treatment of cancer- and chemotherapy-associated anaemia" 24 : 475-482, 2013

12 Caro JJ, "Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, Table 3. Cox regression model for tumor stage, presence of a stoma, involvement of lymph nodes, and presence of anemia Variable Beta Standard error t-value P-value Tumor stage –0.6910.864–0.7990.42Stoma 0.5950.5191.1460.25Lymph-node involvement 1.5200.8551.7570.08Anemia 0.8290.5051.6420.10quantitative review" 91 : 2214-2221, 2001

13 Cancer Research UK., "Anal cancer statistics [Internet]"