Significant prognostic impact of chemoradiotherapy-induced hemoglobin decrease on treatment outcomes of nasopharyngeal carcinoma. Liang, X., Li, Q., Su, Z., Lan, X., Ouyang, P., Mao, Y., Shi, D., Deng, W., Cheng, Z., Wang, S., & Xie, F. Journal of Cancer, 6(6):502–510, 2015.
doi  abstract   bibtex   
PURPOSE To investigate prognostic impact of chemoradiotherapy-induced hemoglobin (Hb) decrease on treatment outcomes of endemic nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS Eight hundred and fifteen non-metastatic NPC, receiving neoadjuvant chemotherapy followed by radiotherapy (NACT+RT group) or concomitant chemoradiotherapy (CCRT group), were enrolled in this study, who were regrouped according to pre-radiotherapy Hb (pre-RT Hb), post-radiotherapy Hb (post-RT Hb) and individual Hb decrease through radiotherapy or CCRT (△Hb), respectively. Survival curves were estimated using Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using the COX proportional hazard model and binary logistic regression model. RESULTS A poorer 5-year disease-free survival (DFS) was observed when pre-RT Hb\textless130.00 g/L. However, post-RT Hb\textless130.00 g/L was associated with significantly poorer 5-year locoregional recurrence-free survival (LRFS) (P=0.010) and disease specific survival (DSS) (P=0.008). Multivariate analysis with the COX proportional hazard model identified post-RT Hb\textless130.00 g/L as an independent negative prognostic factor for both LRFS (hazard ratio [HR], 1.896; 95% confidence interval [CI], 1.158-3.106; P=0.011) and DSS (HR, 1.767; 95% CI, 1.152-2.711; P=0.009). Similarly, △Hb \textless-15.00 g/L also predicted poorer 5-year LRFS (P=0.024) and DSS (P=0.015), which was confirmed in multivariate analysis as an independent adverse prognostic factor for LRFS (HR, 1.586; 95% CI, 1.058-2.377; P=0.026) and DSS (HR, 1.556; 95% CI, 1.087-2.227; P=0.016), respectively. Multivariate analysis with binary logistic regression model indicated that CCRT was a significantly independent predictor for post-RT Hb \textless130.00 g/L and △Hb \textless -15.00 g/L. CONCLUSIONS Chemoradiotherapy-induced decreased Hb levels have negative influence on locoregional control and survival, and might counteract the benefit of neoadjuvant/concomitant chemotherapy. Further studies on supportive care to maintain sufficient Hb level during chemo-radiotherapy are warranted.
@article{liang_significant_2015,
	title = {Significant prognostic impact of chemoradiotherapy-induced hemoglobin decrease on treatment outcomes of nasopharyngeal carcinoma},
	volume = {6},
	issn = {1837-9664},
	doi = {10.7150/jca.11403},
	abstract = {PURPOSE

To investigate prognostic impact of chemoradiotherapy-induced hemoglobin (Hb) decrease on treatment outcomes of endemic nasopharyngeal carcinoma (NPC).


MATERIALS AND METHODS

Eight hundred and fifteen non-metastatic NPC, receiving neoadjuvant chemotherapy followed by radiotherapy (NACT+RT group) or concomitant chemoradiotherapy (CCRT group), were enrolled in this study, who were regrouped according to pre-radiotherapy Hb (pre-RT Hb), post-radiotherapy Hb (post-RT Hb) and individual Hb decrease through radiotherapy or CCRT (△Hb), respectively. Survival curves were estimated using Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using the COX proportional hazard model and binary logistic regression model.


RESULTS

A poorer 5-year disease-free survival (DFS) was observed when pre-RT Hb{\textless}130.00 g/L. However, post-RT Hb{\textless}130.00 g/L was associated with significantly poorer 5-year locoregional recurrence-free survival (LRFS) (P=0.010) and disease specific survival (DSS) (P=0.008). Multivariate analysis with the COX proportional hazard model identified post-RT Hb{\textless}130.00 g/L as an independent negative prognostic factor for both LRFS (hazard ratio [HR], 1.896; 95\% confidence interval [CI], 1.158-3.106; P=0.011) and DSS (HR, 1.767; 95\% CI, 1.152-2.711; P=0.009). Similarly, △Hb {\textless}-15.00 g/L also predicted poorer 5-year LRFS (P=0.024) and DSS (P=0.015), which was confirmed in multivariate analysis as an independent adverse prognostic factor for LRFS (HR, 1.586; 95\% CI, 1.058-2.377; P=0.026) and DSS (HR, 1.556; 95\% CI, 1.087-2.227; P=0.016), respectively. Multivariate analysis with binary logistic regression model indicated that CCRT was a significantly independent predictor for post-RT Hb {\textless}130.00 g/L and △Hb {\textless} -15.00 g/L.


CONCLUSIONS

Chemoradiotherapy-induced decreased Hb levels have negative influence on locoregional control and survival, and might counteract the benefit of neoadjuvant/concomitant chemotherapy. Further studies on supportive care to maintain sufficient Hb level during chemo-radiotherapy are warranted.},
	number = {6},
	journal = {Journal of Cancer},
	author = {Liang, Xue-Xia and Li, Qun and Su, Zhen and Lan, Xiao-Wen and Ouyang, Pu-Yun and Mao, Yan-Ping and Shi, Ding-Bo and Deng, Wu-Guo and Cheng, Zhi-Bin and Wang, Si-Yang and Xie, Fang-Yun},
	year = {2015},
	pmid = {26000040},
	pages = {502--510}
}

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