title: Association between pretreatment haemoglobin levels and morphometric characteristics of the tumour, response to neoadjuvant treatment and long-term outcomes in patients with locally advanced rectal cancers.
abstract: OBJECTIVE
  The study was carried out to investigate whether pretreatment haemoglobin (Hb) levels act as a biomarker in the management of patients with locally advanced rectal cancer.
  
  
  METHODS
  We prospectively collected data on all patients within our cancer network with localized low rectal cancer treated with preoperative radiotherapy/chemoradiotherapy at Mount Vernon Centre for Cancer Treatment between March 1994 and July 2008. Pretreatment Hb level was assessed as an independent variable for the whole study sample and dichotomised at a value of 12 g/dl. A multivariate analysis of covariance (MANCOVA) was conducted on parameters that had significant association on univariate analysis of covariance (ANCOVA) and correlational (Kendall tau/Pearson) analyses. Kaplan-Meier survival analysis and Cox proportional hazard models were used to determine significant prognostic markers. Statistical significance was set at 0.05.
  
  
  RESULTS
  463 patients (male/female 2:1; median age = 66 years, interquartile range = 56.5-73.0) were included in the analysis. There was significant tumour response of T stage (P < 0.001) and N stage (P < 0.001), with 17.6% of patients achieving a pathological complete response. Pretreatment Hb value was inversely related to the craniocaudal vertical tumour length (P = 0.02) and pretreatment T stage of the tumour (P = 0.01). Patients with Hb levels of < 12 g/dl and moderately differentiated adenocarcinoma were less responsive. Local recurrence was more common in patients with a pretreatment Hb of < 12 g/dl (hazard ratio = 1.78) over a median follow up of 24 months, but this was not statistically significant (P = 0.08).
  
  
  CONCLUSIONS
  The pretreatment Hb level might be used as a biomarker of rectal tumour morphology, response to neoadjuvant chemoradiation and risk of local recurrence.
authors.affiliation: Department of Gastrointestinal Research, Mount Vernon Cancer Treatment and Research Centre, London, UK.
authors.forename: A A
authors.initials: AA
authors.lastname: Khan
authors.forename: M
authors.initials: M
authors.lastname: Klonizakis
authors.forename: A
authors.initials: A
authors.lastname: Shabaan
authors.forename: R
authors.initials: R
authors.lastname: Glynne-Jones
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology* / Q000628:therapy*; D000368:Aged; D000740:Anemia / Q000150:complications; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D059186:Chemoradiotherapy, Adjuvant; D019583:Dose Fractionation, Radiation; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012004:Rectal Neoplasms / Q000097:blood / Q000473:pathology* / Q000628:therapy*
chemical_list: D014408:Biomarkers, Tumor; D006454:Hemoglobins
keywords: Rectal carcinoma; chemoradiation; haemoglobin; neoadjuvant; radiotherapy