title: Impact of haemoglobin levels during adjuvant chemotherapy on the survival of patients with primary breast cancer.
abstract: Tumour anaemia is a common symptom in cancer patients, particularly in those receiving chemotherapy. The aim of the current study was to analyse the impact of haemoglobin levels on the prognosis of patients with primary breast cancer receiving adjuvant chemotherapy. A total of 129 patients were available for analysis. The estimated median five-year overall survival rate was 76.6%. Mean Hb prior to primary surgery was 13.8 g/dl (SD 1.09), pre-chemotherapy Hb 12.8 g/dl (SD 1.2), and nadir Hb during chemotherapy 11.0 g/dl (SD1.1), respectively. Hb values were analysed as continuous variables in the Cox model. Survival analyses did not show a correlation between preoperative and pre-chemotherapy Hb levels with patient outcome. However, univariate analysis identified low nadir Hb (p=0.008), larger tumours (p=0.042), and hormone-receptor-negative tumours (p=0.022) to be significantly associated with poor patient survival. This result was persistent when analysis was adjusted for relevant prognostic factors in a multivariate Cox proportional hazards model. Nadir Hb, 1.54-fold increased risk for death (95% CI 1.03-2.32), and tumour size, 3.2-fold increased risk (95% CI 1.17-8.77) remained as independent variables, whereas hormone-receptor status failed to retain significance. The present data showed anaemia during adjuvant chemotherapy to be associated with poor survival in patients with primary breast cancer. Prospective randomized trials are warranted to examine the value of correcting anaemia with regard to improve disease control and survival.
authors.affiliation: Department of Gynaecology and Obstetrics, Krankenhaus Lainz, Vienna, Austria. pec@gyn.khl.magwien.gv.at
authors.forename: Christian
authors.initials: C
authors.lastname: Peters-Engl
authors.forename: Pia
authors.initials: P
authors.lastname: Cassik
authors.forename: Irene
authors.initials: I
authors.lastname: Schmidt
authors.forename: Ursula
authors.initials: U
authors.lastname: Denison
authors.forename: Michael
authors.initials: M
authors.lastname: Medl
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Pokieser
authors.forename: Paul
authors.initials: P
authors.lastname: Sevelda
mesh_terms: D000368:Aged; D000740:Anemia / Q000139:chemically induced* / Q000150:complications; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001317:Austria; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D001952:Bridged-Ring Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005260:Female; D006454:Hemoglobins / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D013629:Tamoxifen / Q000009:adverse effects* / Q000627:therapeutic use; D043823:Taxoids / Q000009:adverse effects* / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D001952:Bridged-Ring Compounds; D006454:Hemoglobins; D043823:Taxoids; D013629:Tamoxifen; C080625:taxane