title: 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.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Tomasz M
authors.initials: TM
authors.lastname: Beer
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Tangen
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Bland
authors.forename: Maha
authors.initials: M
authors.lastname: Hussain
authors.forename: Bryan H
authors.initials: BH
authors.lastname: Goldman
authors.forename: Thomas G
authors.initials: TG
authors.lastname: DeLoughery
authors.forename: E David
authors.initials: ED
authors.lastname: Crawford
mesh_terms: 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
chemical_list: D018931:Antineoplastic Agents, Hormonal; D006454:Hemoglobins