Effect of Anemia on Disease Outcome

A Hb concentration >11.0 g/dL was a significantly (p = 0.001) favorable prognostic factor in a large retrospective analysis of 2531 patients with advanced NSCLC (67). The relationship between anemia and survival was examined in a review of 60 papers, 25% of which were about lung cancer (3). The relative risk of death of anemic patients with lung cancer increases by 19% (95% confidence interval (CI): 10-29). This effect is present regardless of whether the patients are treated with chemotherapy, radiotherapy, or surgery (4). An important additional question is whether this effect is because the lower Hb values are a sign of more advanced disease, or whether the anemia compromises anticancer treatment and thereby survival. In the last scenario, treatment of anemia might improve disease control and outcome. Several theoretical arguments (the role of tumor hypoxia in resistance to therapy [68]) and patient data, in the fields of both radiotherapy (especially for head-and-neck and gynecologic cancers) and chemotherapy, suggest the last direction (61,69,70).

The possible relationship between increased Hb values and survival was explored in a recent randomized, double-blind, trial of rHuEPO vs. placebo in 375 anemic patients with solid or nonmyeloid tumors receiving nonplatinum chemotherapy (61). The study was not designed or powered for survival analysis, but the trend toward better survival (p = 0.13 univariate; p = 0.05 multivariate) for the rHuEPO-treated patients was nonetheless noteworthy.

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