Wilairat Wanitchar, Benjapibal Mongkol
Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Asian Pac J Cancer Prev. 2012;13(7):3187-90. doi: 10.7314/apjcp.2012.13.7.3187.
This study evaluated the relationship between pretreatment hemoglobin (Hb) and prognostic factors in Thai patients with endometrial cancer. Medical records of 228 patients who had undergone surgery between January 2005 and December 2007 were retrospectively reviewed. Associations between clinicopathological variables and pretreatment Hb levels were described using Pearson's chi square test or two-tailed Fisher's exact test. Survival analysis was performed with Kaplan-Meier estimates. Univariate and Cox-regression models were used to evaluate the prognostic impact of various factors, including Hb levels, in term of disease-free survival. The median duration of follow-up was 38.2 months. Eighty-nine patients (39%) had a preoperative Hb level of <12 g/dL, these having significantly higher rates of non-endometrioid histology, advanced FIGO stage, lymphovascular space invasion, cervical involvement, adnexal involvement, positive peritoneal cytology, and lymph node involvement than patients with Hb ≥12 g/dL. The 5-year disease-free and overall survival were significantly lower in patients with pretreatment Hb levels <12 g/dL compared with those with Hb ≥12 g/dL (79.3% vs. 89.2%, p=0.044 and 87.6% vs. 99.3%, p<0.001, respectively). In the multivariate analysis only histology, myometrial invasion, and lymphovascular invasion proved to be independent prognostic factors, whereas tumor grading, stage, cervical involvement, adnexal involvement, positive peritoneal cytology, lymph node involvement, and low Hb were not. In conclusion, presence of anemia before treatment may reflect poor prognostic factors in patients with endometrial cancer and low pretreatment hemoglobin level may have a prognostic impact on clinical outcome.
本研究评估了泰国子宫内膜癌患者治疗前血红蛋白（Hb）与预后因素之间的关系。回顾性分析了2005年1月至2007年12月期间接受手术的228例患者的病历。使用Pearson卡方检验或双尾Fisher精确检验描述临床病理变量与治疗前Hb水平之间的关联。采用Kaplan-Meier估计进行生存分析。使用单变量和Cox回归模型评估包括Hb水平在内的各种因素对无病生存期的预后影响。中位随访时间为38.2个月。89例患者（39%）术前Hb水平<12 g/dL，与Hb≥12 g/dL的患者相比，这些患者的非子宫内膜样组织学、国际妇产科联盟（FIGO）晚期、淋巴管间隙浸润、宫颈受累、附件受累、腹腔细胞学阳性和淋巴结受累的发生率显著更高。治疗前Hb水平<12 g/dL的患者5年无病生存率和总生存率显著低于Hb≥12 g/dL的患者（分别为79.3%对89.2%，p=0.044；87.6%对99.3%，p<0.001）。多变量分析显示，只有组织学、肌层浸润和淋巴管浸润是独立的预后因素，而肿瘤分级、分期、宫颈受累、附件受累、腹腔细胞学阳性、淋巴结受累和低Hb不是。总之，治疗前存在贫血可能反映子宫内膜癌患者的预后不良因素，治疗前血红蛋白水平低可能对临床结局有预后影响。
