Thorac Cardiovasc Surg 2008; 56(3): 148-153
DOI: 10.1055/s-2007-989455
Original Thoracic

© Georg Thieme Verlag KG Stuttgart · New York

Does Anemia Affect Outcome after Lobectomy or Pneumonectomy in Early Stage Lung Cancer Patients Who Have not Received Neo-Adjuvant Treatment?

T. Chamogeorgakis1 , C. Anagnostopoulos1 , G. Kostopanagiotou2 , F. Bhora3 , I. Toumpoulis2 , E. Georgiannakis2 , A. Nabong3 , T. Dosios2 , L. Harrison3 , C. Connery3
  • 1Department of Cardiothoracic Surgery, Attikon University Hospital, Voula, Greece
  • 2Department of Anesthesiology, Attikon University Hospital, Athens, Greece
  • 3Department of Cardiothoracic Surgery and Radiation Oncology, Continuum Cancer Centers, St. Lukes and Roosevelt Hospital, New York, United States
Further Information

Publication History

received August 6, 2007

Publication Date:
26 March 2008 (online)

Abstract

Backround: Preoperative anemia has been shown to be an ominous prognostic factor for survival in patients with early stage non small cell lung cancer. Methods: Two hundred and fourteen patients underwent resection for early stage non small cell lung cancer between 2001 and 2006 without neo-adjuvant treatment. Patients were divided into four groups based on their admission hemoglobin (Hgb): group I: Hgb ≤ 12 g/dl, group II: Hgb = 12.1 - 12.9 g/dl, group III: Hgb = 13.0 - 14.0 g/dl, and group IV: Hgb > 14 g/dl. Cox regression analysis was used to evaluate each variable's impact on midterm survival taking all causes and lung cancer-specific mortality into account. Kaplan-Meier survival plots were estimated. Results: Preoperative hemoglobin (HR = 1.44, 95 % confidence intervals 1.08 - 1.94, p = 0.014) and pneumonectomy (HR = 3.58, 95 % confidence intervals 1.26 - 10.16, p = 0.017) were the only predictors of all-cause midterm mortality. Similarly, when only lung cancer-related mortality was considered, preoperative hemoglobin (HR = 1.81, 95 % confidence intervals 1.17 - 2.78, p = 0.007) and pneumonectomy (HR = 6.89, 95 % confidence intervals 2.29 - 20.73, p = 0.001,) were independent predictors. Age, gender, pulmonary function test results, tumor stage, and histology did not influence survival. Conclusions: Preoperative anemia and the type of resection in early stage non small cell lung cancer have an impact on midterm survival and lung cancer-specific mortality.

References

  • 1 Jemal A, Siegel R, Ward E. et al . Cancer statistics, 2006.  CA Cancer J Clin. 2006;  56 106-130
  • 2 Pairolero P C, Williams D E, Bergstralh E J. et al . Postsurgical stage I bronchogenic carcinoma: morbid implications of recurrent disease.  Ann Thorac Surg. 1984;  38 331-338
  • 3 Thomas P, Rubinstein L. Cancer recurrence after resection: T1 N0 non-small cell lung cancer. Lung Cancer Study Group.  Ann Thorac Surg. 1990;  49 242-246
  • 4 Batevik R, Grong K, Segadal L, Stangeland L. The female gender has a positive effect on survival independent of background life expectancy following surgical resection of primary non-small cell lung cancer: a study of absolute and relative survival over 15 years.  Lung Cancer. 2005;  47 173-181
  • 5 Bouchardy C, Fioretta G, de Perrot M, Obradovic M, Spiliopoulos A. Determinants of long term survival after surgery for cancer of the lung: a population-based study.  Cancer. 1999;  86 2229-2237
  • 6 Jazieh A R, Hussain M, Howington J A. et al . Prognostic factors in patients with surgically resected stages I and II non-small cell lung cancer.  Ann Thorac Surg. 2000;  70 1168-1171
  • 7 Yovino S, Kwok Y, Krasna M, Bangalore M, Suntharalingam M. An association between preoperative anemia and decreased survival in early-stage non-small-cell lung cancer patients treated with surgery alone.  Int J Radiat Oncol Biol Phys. 2005;  62 1438-1443
  • 8 Williams B C, Demitrack L B, Fries B E. The accuracy of the National Death Index when personal identifiers other than Social Security number are used.  Am J Public Health. 1992;  82 1145-1147
  • 9 Kaplan E L, Meier P. Nonparametric estimation from incomplete observations.  J Am Stat Assoc. 1958;  53 547-581
  • 10 Cox D R. Regression models and life-tables.  J R Stat Soc. 1972;  34 187-220
  • 11 Wigren T, Oksanen H, Kellokumpu-Lehtinen P. A practical prognostic index for inoperable non-small-cell lung cancer.  J Cancer Res Clin Oncol. 1997;  123 259-266
  • 12 Harrison L B, Chadha M, Hill R J, Hu K, Shasha D. Impact of tumor hypoxia and anemia on radiation therapy outcomes.  Oncologist. 2002;  7 492-508
  • 13 Weinstein D A, Roy C N, Fleming M D. et al . Inappropriate expression of hepcidin is associated with iron refractory anemia: implications for the anemia of chronic disease.  Blood. 2002;  100 3776-3781
  • 14 Beguin Y. Erythropoietin and the anemia of cancer.  Acta Clin Belg. 1996;  51 36-52
  • 15 Paul I, Lappin T R, Maxwell P, Graham A N. Pre-operative plasma erythropoietin concentration and survival following surgery for non-small cell lung cancer.  Lung Cancer. 2006;  51 329-334
  • 16 Tartter P I. The association of perioperative blood transfusion with colorectal cancer recurrence.  Ann Surg. 1992;  216 633-638
  • 17 Sanfilippo F, Vaughn W K, Bollinger R R, Spees E K. The influence of pretransplant transfusions, using different blood products, on patient sensitization and renal allograft survival.  Transplantation. 1984;  37 350-356
  • 18 Tobu M, Iqbal O, Fareed D. et al . Erythropoietin-induced thrombosis as a result of increased inflammation and thrombin activatable fibrinolytic inhibitor.  Clin Appl Thromb Hemost. 2004;  10 225-232
  • 19 Aapro M, Coiffier B, Dunst J, Osterborg A, Burger H U. Effect of treatment with epoetin beta on short-term tumour progression and survival in anaemic patients with cancer: a meta-analysis.  Br J Cancer. 2006;  95 1467-1473
  • 20 Bernet F, Brodbeck R, Guenin M O. et al . Age does not influence early and late tumor-related outcome for bronchogenic carcinoma.  Ann Thorac Surg. 2000;  69 913-918
  • 21 Alexiou C, Beggs D, Onyeaka P. et al . Pneumonectomy for stage I (T1N0 and T2N0) non-small cell lung cancer has potent, adverse impact on survival.  Ann Thorac Surg. 2003;  76 1023-1028
  • 22 Ferguson M K, Karrison T. Does pneumonectomy for lung cancer adversely influence long-term survival?.  J Thorac Cardiovasc Surg. 2000;  119 440-448
  • 23 Alexiou C, Onyeaka C V, Beggs D. et al . Do women live longer following lung resection for carcinoma?.  Eur J Cardiothorac Surg. 2002;  21 319-325
  • 24 Peduzzi P, Concato J, Kemper E, Holford T R, Feinstein A R. A simulation study of the number of events per variable in logistic regression analysis.  J Clin Epidemiol. 1996;  49 1373-1379

Dr. Themistokles Chamogeorgakis

Department of Cardiothoracic Surgery
Attikon University Hospital

Sofokleous 36

16673 Voula

Greece

Email: thchamogeorgakis@yahoo.com