局部晚期头颈癌患者接受手术及术后放疗时不同治疗时间贫血的预后价值

The prognostic value of anaemia at different treatment times in patients with locally advanced head and neck cancer treated with surgery and postoperative radiotherapy.

作者信息

Dietl B, Marienhagen J, Schäfer C, Kölbl O

机构信息

Klinik für Strahlentherapie, University of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042 Regensburg, Germany.

出版信息

Clin Oncol (R Coll Radiol). 2007 May;19(4):228-33. doi: 10.1016/j.clon.2007.02.009. Epub 2007 Mar 12.

DOI:10.1016/j.clon.2007.02.009

PMID:17433968

Abstract

AIMS

We report a retrospective mono-institutional analysis of anaemia (< 12 g/dl) at different treatment times (preoperative, postoperative, before radiotherapy and nadir levels during radiotherapy) in head and neck cancer patients treated with surgery and postoperative radiotherapy. The study objective was to determine whether, and at which time points, anaemia had a significant effect on the end points overall survival and local recurrence-free survival (LRFS).

MATERIALS AND METHODS

The end points for the statistical analysis in 130 patients were LRFS and overall survival. A univariate analysis (Log-rank test) was carried out on the following variables with potential end point-related impact: gender, T, N, G, American Joint Committee on Cancer (AJCC) stage, tumour site, resection status, overall treatment time (OTT), radiotherapy treatment time (RTT) and preoperative, postoperative, pre-radiotherapy and nadir levels of haemoglobin during radiotherapy. Individual variables with a significant effect (P=0.05) were then subjected to multivariate Cox regression analysis.

RESULTS

The median overall survival was 59 months. The univariate analysis showed that AJCC stage (P=0.0268), resection status (P=0.0407), preoperative haemoglobin level (P=0.0087), postoperative haemoglobin level (P=0.0035), RTT (P=0.0042) and OTT (P=0.0343) significantly influenced overall survival. OTT (P=0.0130) and postoperative haemoglobin (P=0.0243) had a significant effect on LRFS. The multivariate Cox regression analysis showed postoperative haemoglobin < 12 g/dl and OTT>100 days to be independent negative prognostic factors for both end points.

CONCLUSIONS

Postoperative acute anaemia < 12 g/dl and an OTT>100 days were independent negative prognostic factors for LRFS and overall survival in patients with head and neck cancer treated with surgery and postoperative radiotherapy.

摘要

目的

我们报告了一项对接受手术及术后放疗的头颈癌患者在不同治疗时间（术前、术后、放疗前以及放疗期间的最低点水平）出现贫血（血红蛋白<12 g/dl）情况的单机构回顾性分析。研究目的是确定贫血是否以及在哪些时间点对总生存和局部无复发生存（LRFS）这些终点指标有显著影响。

材料与方法

对130例患者进行统计分析的终点指标为LRFS和总生存。对以下可能与终点指标相关的变量进行单因素分析（对数秩检验）：性别、T分期、N分期、G分级、美国癌症联合委员会（AJCC）分期、肿瘤部位、切除状态、总治疗时间（OTT）、放疗治疗时间（RTT）以及放疗期间血红蛋白的术前、术后、放疗前和最低点水平。然后对具有显著影响（P=0.05）的个体变量进行多因素Cox回归分析。

结果

总生存的中位数为59个月。单因素分析显示，AJCC分期（P=0.0268）、切除状态（P=0.0407）、术前血红蛋白水平（P=0.0087）、术后血红蛋白水平（P=0.0035）、RTT（P=0.0042）和OTT（P=0.0343）对总生存有显著影响。OTT（P=0.0130）和术后血红蛋白（P=0.0243）对LRFS有显著影响。多因素Cox回归分析显示，术后血红蛋白<12 g/dl和OTT>100天是这两个终点指标的独立阴性预后因素。