title: Anemia is a significant prognostic factor in local relapse-free survival of premenopausal primary breast cancer patients receiving adjuvant cyclophosphamide/methotrexate/5-fluorouracil chemotherapy.
abstract: OBJECTIVE
  To determine the effects of anemia on local relapse-free, relapse-free, and overall survival (LRFS, RFS, and OS, respectively) in premenopausal, primary breast cancer patients receiving adjuvant polychemotherapy, and to determine which conventional prognostic factors affected these outcomes.
  
  
  METHODS
  Four hundred twenty-four premenopausal patients with early-stage primary breast cancer and hormone receptor-expressing tumors were treated with i.v. cyclophosphamide/methotrexate/5-fluorouracil (CMF) polychemotherapy as part of an adjuvant phase III trial (Austrian Breast and Colorectal Cancer Study Group Trial 5). The influence of anemia (hemoglobin <12 g/dL) on LRFS, RFS, and OS was evaluated in a retrospective analysis.
  
  
  RESULTS
  Of 424 patients, 77 (18.2%) developed anemia on CMF chemotherapy. After a median follow-up time of 5 years, 8.9% of nonanemic patients had local relapse compared with 19.6% of anemic patients (P=0.0006). Although mastectomy was associated with anemia (26% versus 13.7% in breast conserving surgery; P=0.002), multivariate analysis did not show mastectomy per se to be a significant risk factor for LRFS. Age, lymph node status, and hemoglobin had an independent significant influence on LRFS (P<0.005). Anemic patients had a relative risk of 2.96 (95% confidence interval, 1.41-6.23) for developing local relapse in comparison with nonanemic patients.
  
  
  CONCLUSIONS
  Premenopausal breast cancer patients who developed anemia during the CMF regimen had significantly worse LRFS. In Austrian Breast and Colorectal Cancer Study Group Trial 5, anemia may have contributed to an almost doubled incidence of local recurrence in the chemotherapy arm. Molecular targets associated with tumor hypoxia and distinct from erythropoiesis should receive further attention in experimental and clinical settings.
authors.affiliation: Department of Surgery, Medical University Vienna, Vienna, Austria. peter.dubsky@meduniwien.ac.at
authors.forename: Peter
authors.initials: P
authors.lastname: Dubsky
authors.forename: Paul
authors.initials: P
authors.lastname: Sevelda
authors.forename: Raimund
authors.initials: R
authors.lastname: Jakesz
authors.forename: Hubert
authors.initials: H
authors.lastname: Hausmaninger
authors.forename: Hellmut
authors.initials: H
authors.lastname: Samonigg
authors.forename: Michael
authors.initials: M
authors.lastname: Seifert
authors.forename: Ursula
authors.initials: U
authors.lastname: Denison
authors.forename: Brigitte
authors.initials: B
authors.lastname: Mlineritsch
authors.forename: Günther
authors.initials: G
authors.lastname: Steger
authors.forename: Werner
authors.initials: W
authors.lastname: Kwasny
authors.forename: Herbert
authors.initials: H
authors.lastname: Stöger
authors.forename: Rupert
authors.initials: R
authors.lastname: Bartsch
authors.forename: Michael
authors.initials: M
authors.lastname: Stierer
authors.forename: Susanne
authors.initials: S
authors.lastname: Taucher
authors.forename: Michael
authors.initials: M
authors.lastname: Fridrik
authors.forename: Walter
authors.initials: W
authors.lastname: Schippinger
authors.forename: Richard
authors.initials: R
authors.lastname: Greil
authors.forename: Richard
authors.initials: R
authors.lastname: Pötter
authors.forename: Michael
authors.initials: M
authors.lastname: Gnant
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications* / Q000453:epidemiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D017697:Premenopause; D011379:Prognosis; D011878:Radiotherapy
chemical_list: D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate