Daly Tiffany, Poulsen Michael G, Denham James W, Peters Lester J, Lamb David S, Krawitz Hedley, Hamilton Chris, Keller Jacqui, Tripcony Lee, Walker Quenten
Division of Oncology Incorporating Queensland Radium Institute, Royal Brisbane Hospital, Herston, QLD 4029, Australia.
Radiother Oncol. 2003 Aug;68(2):113-22. doi: 10.1016/s0167-8140(03)00198-1.
The aims of this analysis were to determine the effect of anaemia on loco-regional control, relapse-free survival, cause-specific survival, overall survival, and acute and late radiation therapy toxicity in patients with Stage III and IV squamous cell carcinoma of the head and neck treated with radiotherapy.
Between 1991 and 1998, 350 patients were randomly assigned to either conventional radiotherapy, (70 Gy in 35 fractions in 49 days) or to accelerated radiotherapy (59.4 Gy in 33 fractions in 24 days). Patients were divided into two groups according to their haemoglobin level: a normal haemoglobin group (>/=13 g/dl in males, >/=12 g/dl in females) and a low haemoglobin group (<13 g/dl in males, <12 g/dl in females). The influence of anaemia on cause-specific survival and the development of confluent mucositis independent of other variables was tested using Cox proportional hazards model.
Of 350 patients recruited to the trial, 238 had haemoglobin measurements and were eligible for inclusion in this secondary analysis. One hundred and ninety-three were considered to have normal haemoglobin, and 45 patients were considered to be anaemic. There were significant differences between the groups in loco-regional control, relapse-free survival, cause-specific survival and overall survival, with hazards ratios of 0.56 (95% confidence interval (CI) 0.34-0.94), 0.57 (95% CI 0.35-0.92), 0.49 (95% CI 0.29-0.85) and 0.43 (95% CI 0.26-0.70) in favour of the normal haemoglobin group. Using Cox proportional hazards modelling, haemoglobin level was a significant predictor of cause-specific survival in addition to disease site, stage, and Eastern Cooperative Oncology Group status. There were no statistically significant differences between the groups in the development of acute or late reactions.
Significant reductions in loco-regional control, disease-free survival, cause-specific survival and overall survival occur in the presence of anaemia. No significant differences in normal tissue toxicity have been identified in this analysis.
本分析旨在确定贫血对头颈部III期和IV期鳞状细胞癌患者接受放射治疗后的局部区域控制、无复发生存率、特定病因生存率、总生存率以及急性和晚期放射治疗毒性的影响。
1991年至1998年期间，350例患者被随机分配接受常规放疗（49天内35次分割，每次2Gy，总剂量70Gy）或加速放疗（24天内33次分割，每次1.8Gy，总剂量59.4Gy）。根据血红蛋白水平将患者分为两组：血红蛋白正常组（男性≥13g/dl，女性≥12g/dl）和低血红蛋白组（男性<13g/dl，女性<12g/dl）。使用Cox比例风险模型测试贫血对特定病因生存率和融合性粘膜炎发生的影响，且不受其他变量影响。
在纳入试验的350例患者中，238例进行了血红蛋白测量，符合纳入本次二次分析的条件。其中193例被认为血红蛋白正常，45例被认为贫血。两组在局部区域控制、无复发生存率、特定病因生存率和总生存率方面存在显著差异，正常血红蛋白组的风险比分别为0.56（95%置信区间[CI]0.34 - 0.94）、0.57（95%CI 0.35 - 0.92）、0.49（95%CI 0.29 - 0.85）和0.43（95%CI 0.26 - 0.70）。使用Cox比例风险模型，除疾病部位、分期和东部肿瘤协作组状态外，血红蛋白水平是特定病因生存率的重要预测因素。两组在急性或晚期反应的发生方面无统计学显著差异。
贫血会导致局部区域控制、无病生存率、特定病因生存率和总生存率显著降低。本分析未发现正常组织毒性存在显著差异。
