title: Pre-operative plasma erythropoietin concentration and survival following surgery for non-small cell lung cancer.
abstract: BACKGROUND
  Suppression of the effect of the hormone erythropoietin (EPO) on the bone marrow, and an inadequate EPO response to anaemia have been shown to be factors in the genesis of cancer related anaemia. Low haemoglobin (Hb) concentration pre-operatively has been shown to have prognostic significance in patients with surgically resected NSCLC. This study investigates the relationship between pre-operative EPO and survival in patients having surgery for NSCLC.
  
  
  METHODS
  Pre-operative plasma EPO concentration and haemoglobin concentration were analysed in patients undergoing surgery for NSCLC between April 1998 and January 1999. Full follow-up was available for all patients.
  
  
  RESULTS
  Forty two patients were included. Median EPO concentration was 9.4 mIU/ml, range (3.7-56.4) with 17 patients (40.4%) having values above the normal range. Median haemoglobin concentration was 13.3g/dl (range 8.5-16.8) with 15 patients (26%) anaemic pre-operatively. Pathological staging revealed 17 (40.4%) patients with stage I, 6 (14.3%) with stage II, 19 (45.3%) with stage III disease. Ten patients had irresectable disease. There was a significant difference in median EPO but not haemoglobin concentration, between the different pathological stages. Survival was significantly lower in patients with pre-operative EPO >10.5 mIU.
  
  
  CONCLUSIONS
  Raised pre-operative EPO is associated with reduced survival in patients having surgery for NSCLC. Its measurement should be considered in the pre-operative assessment of patients undergoing surgery for NSCLC. Further research is required to further investigate the biological relationship between EPO and NSCLC.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Victoria Hospital, Northern Ireland, Belfast, UK. ian.paul@talk21.com
authors.forename: I
authors.initials: I
authors.lastname: Paul
authors.forename: T R J
authors.initials: TR
authors.lastname: Lappin
authors.forename: P
authors.initials: P
authors.lastname: Maxwell
authors.forename: A N J
authors.initials: AN
authors.lastname: Graham
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood* / Q000601:surgery*; D004921:Erythropoietin / Q000097:blood*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D016016:Proportional Hazards Models; D018709:Statistics, Nonparametric; D016019:Survival Analysis
chemical_list: D004921:Erythropoietin