title: Hemoglobin level trajectories in the early treatment period are related with survival outcomes in patients with breast cancer.
abstract: Hemoglobin (Hb) levels are reportedly related with treatment outcomes and survival in patients of breast cancer. However, the long-term change in Hb levels after treatment and the effects of Hb on survival remain unknown. This retrospective cohort study enrolled 1931 breast cancer patients with pathological stage I-IV between 1/1/2003 and 12/31/2013. Latent class modeling was used to identify trajectories in monthly Hb levels over time. The primary endpoint was 10-year cancer-related death. We identified 5 distinct Hb trajectories: persistent anemia (5.6 %; n = 109), improved anemia (4.8 %, n = 93), mild anemia (21.0%; n = 406), low normal Hb (46.6 %; n = 899), and normal Hb (21.9%; n = 424). Compared with the normal-Hb group, trajectories with low Hb levels had worst 10-year survival. The adjusted hazard ratios were 1.79(95% CI, 0.91-3.53) for the improved anemia group, 1.09(95% CI, 0.68-1.74) for the mild anemia group, 1.06 (95% CI, 0.71-1.60) for the low normal Hb group, and 2.19(95% CI 1.28-3.75) for the persistent anemia group. Our findings show there are five Hb level trajectories during breast cancer treatment. The anemia Hb level trajectory during the first 12 months after treatment reflect the worst cancer-related 10-year survival in breast cancer patients.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan.|Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.|Department of Medical Research, Taichung Veterans General Hospital, Taiwan.|Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan.
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Lee
authors.affiliation: Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan.|School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chun-Hao
authors.initials: CH
authors.lastname: Tsai
authors.affiliation: Department of Surgery, Taichung Tzu Chi General Hospital, Taichung, Taiwan.
authors.forename: Dah-Cherng
authors.initials: DC
authors.lastname: Yeh
authors.affiliation: Department of Family Medicine, Taichung Veterans General Hospital, Taiwan.
authors.forename: Chi-Shy
authors.initials: CS
authors.lastname: Lin
authors.affiliation: Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan.
authors.forename: Yu-Fen
authors.initials: YF
authors.lastname: Li
authors.affiliation: School of Medicine, China Medical University, Taichung, Taiwan.|Division of Hematology/Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|Breast Cancer Center, Taichung Veterans General Hospital, Taiwan.
authors.forename: Huey-En
authors.initials: HE
authors.lastname: Tzeng
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000097:blood* / Q000401:mortality; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins
keywords: breast cancer; hemoglobin; survival; trajectory