title: The role of inflammation, iron, and nutritional status in cancer-related anemia: results of a large, prospective, observational study.
abstract: Anemia in oncology patients is often considered a side effect of cancer therapy; however, it may occur before any antineoplastic treatment (cancer-related anemia). This study was aimed to evaluate the prevalence of cancer-related anemia in a large cohort of oncology patients and whether inflammation and malnutrition were predictive of its development and severity. The present study included 888 patients with cancer at different sites between May 2011 and January 2014. Patients were assessed at diagnosis before any cancer treatment. The prevalence of anemia according to the main clinical factors (tumor site, stage and performance status) was analyzed. In each patient markers of inflammation, iron metabolism, malnutrition and oxidative stress as well as the modified Glasgow prognostic score, a combined index of malnutrition and inflammation, were assessed and their role in predicting hemoglobin level was evaluated. The percentage of anemic patients was 63% with the lowest hemoglobin levels being found in the patients with most advanced cancer and compromised performance status. Hemoglobin concentration differed by tumor site and was lowest in patients with ovarian cancer. Hemoglobin concentration was inversely correlated with inflammatory markers, hepcidin, ferritin, erythropoietin and reactive oxygen species, and positively correlated with leptin, albumin, cholesterol and antioxidant enzymes. In multivariate analysis, stage, interleukin-6 and leptin were independent predictors of hemoglobin concentration. Furthermore, hemoglobin was inversely dependent on modified Glasgow Prognostic Score. In conclusion, cancer-related anemia is a multifactorial problem with immune, nutritional and metabolic components that affect its severity. Only a detailed assessment of the pathogenesis of cancer-related anemia may enable clinicians to provide safe and effective individualized treatment.
authors.affiliation: Department of Gynecological Oncology, A. Businco Hospital, Regional Referral Center for Cancer Disease, Cagliari, Italy a.maccio@tin.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Macciò
authors.affiliation: Department of Medical Science "Mario Aresu", University of Cagliari, Italy.
authors.forename: Clelia
authors.initials: C
authors.lastname: Madeddu
authors.affiliation: Medical Oncology Unit, "N.S. Bonaria" Hospital, San Gavino, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Gramignano
authors.affiliation: Medical Oncology Unit, Sirai Hospital, Carbonia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Mulas
authors.affiliation: Department of Medical Oncology, A. Businco Hospital, Regional Referral Center for Cancer Disease, Cagliari, Italy.
authors.forename: Luciana
authors.initials: L
authors.lastname: Tanca
authors.affiliation: Department of Medical Oncology, A. Businco Hospital, Regional Referral Center for Cancer Disease, Cagliari, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Cherchi
authors.affiliation: Medical Oncology Unit, "Nuova Casa di Cura", Decimomannu, Cagliari, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Floris
authors.affiliation: Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, Kagoshima, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Omoto
authors.affiliation: Department of Gynecological Oncology, A. Businco Hospital, Regional Referral Center for Cancer Disease, Cagliari, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Barracca
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Tomas
authors.initials: T
authors.lastname: Ganz
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015415:Biomarkers / Q000032:analysis*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D007501:Iron / Q000378:metabolism*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000097:blood* / Q000150:complications* / Q000276:immunology; D009752:Nutritional Status; D018384:Oxidative Stress; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D007501:Iron