Nakamura Tomoki, Grimer Robert, Gaston Czar, Carter Simon, Tillman Roger, Abudu Adesegun, Jeys Lee, Sudo Akihiro
Department of Oncology Orthopaedic Surgery, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP, UK,
J Orthop Sci. 2013 Nov;18(6):987-93. doi: 10.1007/s00776-013-0454-6. Epub 2013 Aug 14.
Anaemia is present in more than 30 % of patients with various cancers at the time of initial presentation. Anaemia or a lower level of haemoglobin (Hb) is an indicator of poorer prognosis in many cancers. Several studies have also demonstrated that high levels of proinflammatory cytokines contribute to the development of anaemia. However, no studies have assessed the correlation between anaemia and survival in patients with soft tissue sarcoma. The aim of this study was to elucidate the relationship between anaemia and clinical outcome and to determine whether pretreatment anaemia predicted disease-specific survival in patients with adult soft tissue sarcoma.
A total of 376 patients between 2003 and 2010 were retrospectively reviewed. Patients who presented with metastases or/and local recurrence at diagnosis were excluded from this study.
Hb levels varied from 8.0 to 17.3 g/dl in all patients. Pretreatment anaemia was seen in 114 patients. Hb levels were significantly correlated to C-reactive protein levels (Spearman ρ = -0.54, p < 0.0001). The tumour histological grade, age and tumour size were also significantly correlated to Hb levels. Patients with anaemia had a worse disease-specific survival (52.6 % at 5 years) than those without anaemia (79.7 % at 5 years) (p < 0.0001). Patients with anaemia also had a worse event-free rate (44 % at 5 years) than those without anaemia (66.3 % at 5 years) (p < 0.0001). Multivariate analysis showed that anaemia remained an independent predictor of survival (p = 0.002) and events (p = 0.0003).
Pretreatment anaemia may be indicative of an aggressive characteristic in patients with soft tissue sarcoma. We recommend the routine measurement of Hb level to identify patients who are at greater risk of death or an event.
超过30%的各类癌症患者在初次就诊时存在贫血。贫血或较低水平的血红蛋白（Hb）是许多癌症预后较差的一个指标。多项研究还表明，高水平的促炎细胞因子会导致贫血的发生。然而，尚无研究评估软组织肉瘤患者贫血与生存之间的相关性。本研究的目的是阐明贫血与临床结局之间的关系，并确定成人软组织肉瘤患者治疗前贫血是否可预测疾病特异性生存。
回顾性分析了2003年至2010年间的376例患者。本研究排除了诊断时出现转移或/和局部复发的患者。
所有患者的Hb水平在8.0至17.3g/dl之间。114例患者存在治疗前贫血。Hb水平与C反应蛋白水平显著相关（Spearman ρ=-0.54，p<0.0001）。肿瘤组织学分级、年龄和肿瘤大小也与Hb水平显著相关。贫血患者的疾病特异性生存率（5年时为52.6%）低于无贫血患者（5年时为79.7%）（p<0.0001）。贫血患者的无事件发生率（5年时为44%）也低于无贫血患者（5年时为66.3%）（p<0.0001）。多变量分析显示，贫血仍然是生存（p=0.002）和事件（p=0.0003）的独立预测因素。
治疗前贫血可能表明软组织肉瘤患者具有侵袭性特征。我们建议常规检测Hb水平，以识别死亡或发生事件风险更高的患者。
