title: Even a mild anemia is related to tumor aggressiveness mediated by angiogenic factors.
abstract: Esophagogastric cancers have high recurrence rates with lymph nodes being a common pattern. Pre-treatment anemia has been reported an independent prognostic factor of treatment failure regardless of treatment strategy, particularly associated with poor locoregional control. A causative relationship between anemia - tumor hypoxia - tumor aggressiveness mediated by angiogenesis up-regulation is advocated, yet remains controversial.
  
  
  OBJECTIVE
  To determine whether and how the pre-treatment anemia is associa-ted with various aspects of disease aggressiveness and to evaluate the possible involvement of angiogenesis mediators.
  
  
  METHODS
  In 111 esophagogastric cancer patients we investigated the association of pre-treatment hemoglobin concentration and anemia presence with cancer-related, patients-related features and laboratory parameters including angiogenic factors: vascular endothelial growth factors A and C, interleukin-8 and midkine. Serum levels of angiogenic factors were assessed with immunoenzymatic tests.
  
  
  RESULTS
  Histology, disease stage, regional metastasis and dissemination in general, malnutrition and angiogenesis represented by midkine were found to correlate with anemia presence and hemoglobin concentration, while tumor extension, patient's age and sex accounted only for anemia presence. A tendency towards hemoglobin correlation with VEGF-A and Il-8 was also observed. Midkine, tumor histology and malnutrition were found to exert an independent effect on pre-treatment hemoglobin concentration and anemia presence in esophagogastric cancer patients. Hemoglobin level of 12 g/dL was found an optimal cut-off value for discrimination between localized and disseminated cancers.
  
  
  CONCLUSIONS
  Even a mild pre-treatment anemia is associated with cancers metastasizing especially to regional lymph nodes, which seems to be mediated by some of studied angiogenic factors.
authors.affiliation: Department of Medical Biochemistry, Silesian Piasts University of Medicine, Wroclaw 50-368, Poland. krzystek@bioch.am.wroc.pl
authors.forename: M
authors.initials: M
authors.lastname: Krzystek-Korpacka
authors.forename: M
authors.initials: M
authors.lastname: Matusiewicz
authors.forename: D
authors.initials: D
authors.lastname: Diakowska
authors.forename: K
authors.initials: K
authors.lastname: Grabowski
authors.forename: K
authors.initials: K
authors.lastname: Blachut
authors.forename: I
authors.initials: I
authors.lastname: Kustrzeba-Wojcicka
authors.forename: A
authors.initials: A
authors.lastname: Gamian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications*; D043925:Angiogenesis Inducing Agents / Q000097:blood*; D016207:Cytokines / Q000097:blood / Q000276:immunology; D004938:Esophageal Neoplasms / Q000150:complications* / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016209:Interleukin-8 / Q000097:blood / Q000276:immunology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D000078792:Midkine; D042461:Vascular Endothelial Growth Factor A / Q000097:blood; D042582:Vascular Endothelial Growth Factor C / Q000097:blood
chemical_list: D043925:Angiogenesis Inducing Agents; D016207:Cytokines; D006454:Hemoglobins; D016209:Interleukin-8; C467484:VEGFA protein, human; C467486:VEGFC protein, human; D042461:Vascular Endothelial Growth Factor A; D042582:Vascular Endothelial Growth Factor C; D000078792:Midkine