title: The prognostic value of hemoglobin in patients with anal cancer treated with chemoradiotherapy.
abstract: OBJECTIVE
  This study aimed to evaluate the impact of hemoglobin level on clinical outcome (local response, progression-free survival, and overall survival) in patients with carcinoma of the anal canal treated with definitive chemoradiotherapy.
  
  
  METHODS
  This is a retrospective study of patients with anal cancer treated between 1992 and 2005 with definitive chemoradiotherapy at Tom Baker Cancer Centre. Patient treatment, laboratory, and outcome data were extracted from the chart.
  
  
  RESULTS
  Seventy-two patients treated with definitive chemoradiotherapy were identified. The median age was 56 years, the male-to-female ratio was 1:2, and the median tumor size was 3.5 cm. At 6 weeks after the completion of chemoradiotherapy, 62% of patients (38/61) had complete clinical response, and 34% (21/61) had achieved a partial clinical response. At 3 months after treatment, complete clinical response was observed in 78% (49/63) and a partial response in 16% (10/63). The median pretreatment hemoglobin level was 138.5 g/L, and the median on-treatment hemoglobin level was 129 g/L. Distant relapse was associated with hemoglobin levels in the lowest quartiles, pretreatment and on-treatment (P = .007 and P = .008, respectively). Hemoglobin levels were not associated with response at 6 weeks or 3 months. A pretreatment hemoglobin level of <130 g/L was associated with worse progression-free and overall survival (P < .0001, both). A hemoglobin on-treatment level of <121 g/L was associated with progression-free and overall survival (P < .0001 and P = .019, respectively), when stratified by gender.
  
  
  CONCLUSIONS
  Hemoglobin status was correlated with progression-free and overall survival, and distant relapse, but not clinical response, in patients with carcinoma of the anal canal treated with chemoradiotherapy. The clinically relevant cut point, and the value of correcting hemoglobin levels before or during treatment, remains to be elucidated.
authors.affiliation: Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
authors.forename: Gloria B
authors.initials: GB
authors.lastname: Roldán
authors.forename: Alexander K P
authors.initials: AK
authors.lastname: Chan
authors.forename: Michelle
authors.initials: M
authors.lastname: Buckner
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Magliocco
authors.forename: Corinne M
authors.initials: CM
authors.lastname: Doll
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000532:radiotherapy; D014408:Biomarkers, Tumor / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D006454:Hemoglobins