title: Anaemia prior to operation is related with poorer long-term survival in patients with operable rectal cancer.
abstract: OBJECTIVE
  Local hypoxia has been linked to a higher risk of metastasis in patients with cancer of the uterine cervix and a haemoglobin concentration of 7.45 mmol/l or less. It is unknown whether the same holds true for rectal cancer. We evaluated the independent impact of pre-operative anaemia on survival in patients with rectal cancer.
  
  
  METHODS
  A random set of 144 patients diagnosed with Dukes' A, B or C rectal cancer in the period 1995-1999 and registered in the database of the Eindhoven Cancer Registry was included in a survival analysis. Parameters tested were gender, age, pre-operative haemoglobin concentration, tumour stage and therapy. The ones that showed a relation with survival (log-rank test, p<0.1) were entered in a multivariate analysis.
  
  
  RESULTS
  For patients without pre-operative anaemia, the hazard ratio of death was 0.35 (95% confidence interval 0.19-0.65, p=0.001), which indicates a three times higher mortality risk. For patients with a higher tumour stage (Dukes' B vs. Dukes' A or Dukes' C vs. Dukes' B) the hazard ratio of death was 1.52 (95% CI 1.04-2.23, p=0.03). For older patients (64-73 years vs. <64 years or >73 years vs. 64-73 years) the hazard ratio of death was 1.85 (95% CI 1.29-2.63, p=0.001).
  
  
  CONCLUSIONS
  Long-term survival was significantly affected in rectal cancer patients with pre-operative anaemia. Further study on the relation between anaemia, tumour oxygenation and prognosis is needed, as it may have implications for future therapy.
authors.affiliation: Department of Internal Medicine, Oosterschelde Hospital, P.O. Box 106, 4460 BB Goes, The Netherlands. hvanhalteren@soz.nl
authors.forename: H K
authors.initials: HK
authors.lastname: van Halteren
authors.forename: S
authors.initials: S
authors.lastname: Houterman
authors.forename: C D G W
authors.initials: CD
authors.lastname: Verheij
authors.forename: V E P P
authors.initials: VE
authors.lastname: Lemmens
authors.forename: J W W
authors.initials: JW
authors.lastname: Coebergh
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000740:Anemia / Q000150:complications*; D003082:Colectomy / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D011379:Prognosis; D012004:Rectal Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012042:Registries; D015203:Reproducibility of Results; D016019:Survival Analysis