Ferrandina Gabriella, Distefano Mariagrazia, Smaniotto Daniela, Morganti Alessio, Paglia Amelia, Macchia Gabriella, Corvari Barbara, Lorusso Domenica, Scambia Giovanni
Gynecologic Oncology Unit, Catholic University of Rome, Italy.
Gynecol Oncol. 2006 Nov;103(2):500-5. doi: 10.1016/j.ygyno.2006.03.039. Epub 2006 May 4.
The aim of this study was to investigate the role of anemia at presentation (basal HB) and during treatment (nadir HB) as predictor of pathological response, as well as disease-free (DFS) and overall survival (OS) in LACC patients undergoing chemoradiation followed by radical surgery.
114 consecutive LACC patients were accrued at the Gynecologic Oncology Unit, Catholic University, Rome and at the Department of Oncology, Catholic University of Campobasso, Italy. Neoadjuvant treatment included chemotherapy with cisplatin (20 mg/m2) and 5-fluorouracil (1000 mg/m2, 24-h infusion) (both on days 1-4 and 27-30) and external radiotherapy to the whole pelvic region (22 fractions, 1.8 Gy/day, totaling 39.6 Gy). Clinical responders underwent radical surgery. Hemoglobin levels were recorded and expressed in gram per literx10(-2) (g/dl). The value of 10 g/dl was arbitrarily chosen as cut-off value.
In cases showing high basal HB status, the percentage of pathological response was significantly higher than in patients showing low HB status (76.3% versus 46.7%) (P value=0.027). When logistic regression was applied, only advanced stage remained associated with a poor chance of response to treatment. Cases with low basal HB status had a shorter DFS and OS than cases with a high HB status (P value=0.0001 and 0.0022, respectively). Similar results were obtained when analyzing nadir HB status. In multivariate analysis, high basal HB status, and advanced stage, retained an independent negative prognostic role for DFS and OS.
Anemia identifies LACC patients administered preoperative radiochemotherapy, who are at higher risk of recurrence and death of disease.
本研究旨在探讨初始贫血（基础血红蛋白）及治疗期间贫血（最低血红蛋白）作为接受放化疗后行根治性手术的局部晚期宫颈癌（LACC）患者病理反应、无病生存期（DFS）和总生存期（OS）预测指标的作用。
114例连续的LACC患者纳入罗马天主教大学妇科肿瘤病房及意大利坎波巴索天主教大学肿瘤学系。新辅助治疗包括顺铂（20mg/m²）和5-氟尿嘧啶（1000mg/m²，24小时输注）化疗（均在第1 - 4天和第27 - 30天）以及全盆腔外照射放疗（22次分割，1.8Gy/天，共39.6Gy）。临床缓解者接受根治性手术。记录血红蛋白水平并以克每升×10⁻²（g/dl）表示。任意选择10g/dl作为临界值。
基础血红蛋白水平高的患者病理反应率显著高于基础血红蛋白水平低的患者（76.3%对46.7%）（P值 = 0.027）。应用逻辑回归分析时，仅晚期与治疗反应差的可能性相关。基础血红蛋白水平低的患者DFS和OS均短于基础血红蛋白水平高的患者（P值分别为0.0001和0.0022）。分析最低血红蛋白水平时得到相似结果。多因素分析中，基础血红蛋白水平高及晚期对DFS和OS仍保留独立的不良预后作用。
贫血可识别接受术前放化疗的LACC患者，这些患者疾病复发和死亡风险更高。
