title: Pretreatment Anemia Portends Poor Survival and Nonlocal Disease Progression in Patients with Stage I Non-Small Cell Lung Cancer Treated with Stereotactic Body Radiation Therapy.
abstract: We determined whether pretreatment anemia predicted for poor outcomes in the setting of early-stage NSCLC treated with stereotactic body radiation therapy (SBRT).
  
  
  
  Pretreatment hemoglobin levels were evaluated to determine the association with local, regional, and distant control; disease-free survival; and overall survival. Survival rates were estimated with Kaplan-Meier analysis, and multivariate analysis was completed with adjustment for age, T stage, and radiation dose using the Cox proportional hazards model. Receiver operating characteristic curve analysis was used to determine the optimal pretreatment hemoglobin level that would predict for poor outcomes.
  
  
  
  A total of 147 cases of cases of early-stage NSCLC treated with SBRT were evaluated with a median follow-up of 28.9 months. The 3-year local, regional and distant control rates were 95%, 87%, and 89%, respectively. The 3-year overall survival and disease-free survival rates were 75% and 83%, respectively. On multivariate analysis, a lower pretreatment hemoglobin level predicted for poor regional control, poor disease-free survival, and overall survival (p = 0.02, p = 0.03, p = 0.05, respectively). Pretreatment hemoglobin levels did not predict poor local control. Receiver operating characteristic (ROC) analysis found that pretreatment hemoglobin values less than 12.2 g/dL optimally predicted for poor disease-free survival and regional control. The 3-year disease-free survival for patients with a hemoglobin level of at least 12.2 g/dL was 94% versus 70% in patients with a hemoglobin level less than 12.2 g/dL (p = 0.008).
  
  
  
  In the setting of SBRT for early-stage NSCLC, we found pretreatment anemia to be predictive of aggressive disease with poor overall survival and nonlocal disease progression.
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
authors.forename: Narek
authors.initials: N
authors.lastname: Shaverdian
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
authors.forename: Darlene
authors.initials: D
authors.lastname: Veruttipong
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
authors.forename: Jason
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kupelian
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Steinberg
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California. Electronic address: Percylee@mednet.ucla.edu.
authors.forename: Percy
authors.initials: P
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications*; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D018450:Disease Progression; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008175:Lung Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D016634:Radiosurgery
chemical_list: D006454:Hemoglobins; D015850:Interleukin-6
keywords: Anemia; NSCLC; Outcomes; SBRT