Haemoglobin and creatinine values as prognostic factors for outcome of concurrent radiochemotherapy in locally advanced head and neck cancers : Secondary results of two European randomized phase III trials (ARO 95-06, SAKK 10/94).
BACKGROUND
To determine the influence of baseline laboratory values on treatment outcome in patients with locally advanced head and neck cancer (HNSCC).


METHODS
Data of the randomized trials ARO 95 -06 (n = 384) and SAKK 10 /94 (n = 224) were pooled for a total sample size of 608 patients. Haemoglobin (Hb) and creatinine (Cr) were available at baseline and their association with locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), cancer-specific survival (CSS), and overall survival (OS) was analyzed using univariable and multivariable Cox regression models.


RESULTS
A total of 580 and 564 patients were available with baseline Hb and Cr values in the pooled analysis. Univariable analyses revealed that lower baseline Hb values were significantly associated with decreased LRRFS, DMFS, CSS and OS. This effect remained significant for OS when the treatment arms (radiotherapy [RT] alone vs. chemoradiation [CRT]) were analyzed separately. Higher baseline Cr was associated with improved OS in the pooled analysis. Interestingly, the prognostic value of baseline Cr appeared to be limited to the subgroup of 284 patients who were treated with CRT. In the multivariable Cox regression model lower baseline Hb remained associated with decreased OS both in the patients who received CRT (HR 0.79, 95 % CI 0.66-0.94, p = 0.009) and in those patients who underwent RT alone (HR 0.67, 95 % CI 0.58-0.78, p < 0.001). Increased baseline Cr remained significantly associated with improved OS in patients who underwent CRT (HR 0.79, 95 % CI 0.69-0.92, p = 0.002) but not in those patients who underwent RT alone.


CONCLUSIONS
An association between lower baseline Hb and inferior treatment outcome was confirmed. Baseline Cr was introduced as a prognosticator of outcome after CRT for locally advanced HNSCC.
Departments of Radiation Oncology, Charité Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. pirus.ghadjar@charite.de.
Pirus
P
Ghadjar
University Hospital Essen, Essen, Germany.
Christoph
C
Pöttgen
Departments of Radiation Oncology, Charité Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.|University Hospital Essen, Essen, Germany.
Daniela
D
Joos
SAKK Coordinating Center, Bern, Switzerland.
Stefanie
S
Hayoz
Medical Faculty and University Hospital, Technische Universität Dresden, Dresden, Germany.
Michael
M
Baumann
Kantonsspital Aarau, Aarau, Switzerland.
Stephan
S
Bodis
Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany.
Wilfried
W
Budach
University Hospital Zürich, Zürich, Switzerland.
Gabriela
G
Studer
Departments of Radiation Oncology, Charité Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Carmen
C
Stromberger
University Hospital Basel, Basel, Switzerland.
Frank
F
Zimmermann
Departments of Radiation Oncology, Charité Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
David
D
Kaul
Kantonsspital St. Gallen, St. Gallen, Switzerland.
Ludwig
L
Plasswilm
Department for Head and Neck Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany.
Heidi
H
Olze
Clinique de Genolier, Genolier, Switzerland.
Jacques
J
Bernier
Departments of Radiation Oncology, Charité Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Peter
P
Wust
Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
Daniel M
DM
Aebersold
Departments of Radiation Oncology, Charité Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Volker
V
Budach
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D059248:Chemoradiotherapy / Q000401:mortality* / Q000706:statistics & numerical data*; D003404:Creatinine / Q000097:blood*; D018572:Disease-Free Survival; D005060:Europe / Q000453:epidemiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D006454:Hemoglobins; D003404:Creatinine
Carcinoma, squamous cell of head and neck; Chemotherapy; Creatinine; Hemoglobin; Radiation therapy