title: Post-diagnosis hemoglobin change associates with overall survival of multiple malignancies - results from a 14-year hospital-based cohort of lung, breast, colorectal, and liver cancers.
abstract: BACKGROUND
  Anemia refers to low hemoglobin (Hb) level and is a risk factor of cancer patient survival. The National Comprehensive Cancer Network recently suggested that post-diagnosis Hb change, regardless of baseline Hb level, indicates the potential presence of anemia. However, there is no epidemiological study evaluating whether Hb change has direct prognostic values for cancer patients at the population level.
  
  
  METHODS
  We identified 6675 patients with a diagnosis of primary lung, breast, colorectal, or liver cancer who visited the Kimmel Cancer Center at the Thomas Jefferson University from 1998 to 2011. All patients had at least two Hb measurements within the first six months after diagnosis. We analyzed the main, dose-dependent, and time-dependent effects of Hb changes on patient survival.
  
  
  RESULTS
  Compared to patients with a low Hb change (|∆Hb|≤2.6), those having a |∆Hb|>2.6 exhibited a significantly shorter survival (hazard ratio=1.40, 95% confidence interval 1.31-1.50, P=4.5 × 10(-22), Plog rank=1.6 × 10(-39)). This association remained significant across the four cancer types. Bootstrap resampling validated these findings 100% of the time with P<0.01 in all patients and in patients of individual cancers. The association exhibited an apparent U-shape dose-dependent pattern. Time-dependent modeling demonstrated that the effect of Hb change on the survival of the overall patient population persisted for approximately 4.5 years after diagnosis.
  
  
  CONCLUSIONS
  Post-diagnosis Hb change associates with the survival of multiple cancers and may have clinical values in tailoring anti-anemia treatments. Because Hb level is frequently measured during cancer treatment, Hb changes may be a potentially important variable in building cancer prognosis models.
authors.affiliation: Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: Shaogui
authors.initials: S
authors.lastname: Wan
authors.forename: Yinzhi
authors.initials: Y
authors.lastname: Lai
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Myers
authors.forename: Bingshan
authors.initials: B
authors.lastname: Li
authors.forename: Juan P
authors.initials: JP
authors.lastname: Palazzo
authors.forename: Ashlie L
authors.initials: AL
authors.lastname: Burkart
authors.forename: Guokai
authors.initials: G
authors.lastname: Chen
authors.forename: Jinliang
authors.initials: J
authors.lastname: Xing
authors.forename: Hushan
authors.initials: H
authors.lastname: Yang
mesh_terms: D000740:Anemia / Q000150:complications / Q000401:mortality; D001943:Breast Neoplasms / Q000097:blood* / Q000150:complications / Q000401:mortality; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000097:blood* / Q000150:complications / Q000401:mortality; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood* / Q000150:complications / Q000401:mortality; D008175:Lung Neoplasms / Q000097:blood* / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models
chemical_list: D006454:Hemoglobins