The prognostic value of hemoglobin change after initiating androgen-deprivation therapy for newly diagnosed metastatic prostate cancer: A multivariate analysis of Southwest Oncology Group Study 8894.
BACKGROUND
The objective of this study was to characterize changes in hemoglobin (HGB) levels after the initiation of androgen-deprivation therapy (ADT) in patients with previously untreated, metastatic prostate cancer who were enrolled in a large clinical trial.


METHODS
The multivariate associations between 3-month change in HGB and baseline characteristics were evaluated with a linear regression model. The associations between 3-month change in HGB level and time-to-event outcomes, including overall survival and progression-free survival, were evaluated by using proportional hazards regression models.


RESULTS
Quartiles of baseline HGB levels were < or =12.0 g/dL, from 12.1 to 13.7 g/dL, from 13.8 to 14.7 g/dL, and >14.7 g/dL. Overall, 3 months after initiating ADT, the mean HGB level declined 0.54 g/dL (standard deviation [SD], 1.68 g/dL); however, the mean HGB level increased by 0.99 g/dL (SD, 1.83 g/dL) in patients who had baseline HGB levels <12 g/dL and decreased 1.04 g/dL (SD, 1.28 g/dL) in patients who had baseline HGB levels > or =12 g/dL. After adjusting for potential confounders, including baseline HGB level, a decline in HGB after 3 months of ADT was associated independently with shorter survival (hazards ratio [HR], 1.10 per 1 g/dL decline; P = .0035) and shorter progression-free survival (HR, 1.08 per 1 g/dL decline; P = .013). An unexpected finding was that the effect of baseline HGB on overall and progression-free survival varied significantly by race.


CONCLUSIONS
In a sample of men with newly diagnosed, metastatic prostate cancer, a decline in HGB level after 3 months of ADT was associated with shorter survival and progression-free survival after adjusting for disease status and other baseline covariates. Although race alone was not a strong predictor of death or disease progression, the effect of the baseline HGB level on overall and progression-free survival varied significantly by race.
Beer
Tomasz M
TM
Department of Medicine, Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon, USA.
Tangen
Catherine M
CM
Bland
Lisa B
LB
Hussain
Maha
M
Goldman
Bryan H
BH
DeLoughery
Thomas G
TG
Crawford
E David
ED
D000368:Aged; D000740:Anemia / Q000175:diagnosis* / Q000453:epidemiology; D018931:Antineoplastic Agents, Hormonal; D015897:Comorbidity; D018572:Disease-Free Survival; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D015995:Prevalence; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology
D018931:Antineoplastic Agents, Hormonal; D006454:Hemoglobins