Macciò Antonio, Madeddu Clelia, Gramignano Giulia, Mulas Carlo, Tanca Luciana, Cherchi Maria Cristina, Floris Carlo, Omoto Itaru, Barracca Antonio, Ganz Tomas
Department of Gynecological Oncology, A. Businco Hospital, Regional Referral Center for Cancer Disease, Cagliari, Italy
Department of Medical Science "Mario Aresu", University of Cagliari, Italy.
Haematologica. 2015 Jan;100(1):124-32. doi: 10.3324/haematol.2014.112813. Epub 2014 Sep 19.
Anemia in oncology patients is often considered a side effect of cancer therapy; however, it may occur before any antineoplastic treatment (cancer-related anemia). This study was aimed to evaluate the prevalence of cancer-related anemia in a large cohort of oncology patients and whether inflammation and malnutrition were predictive of its development and severity. The present study included 888 patients with cancer at different sites between May 2011 and January 2014. Patients were assessed at diagnosis before any cancer treatment. The prevalence of anemia according to the main clinical factors (tumor site, stage and performance status) was analyzed. In each patient markers of inflammation, iron metabolism, malnutrition and oxidative stress as well as the modified Glasgow prognostic score, a combined index of malnutrition and inflammation, were assessed and their role in predicting hemoglobin level was evaluated. The percentage of anemic patients was 63% with the lowest hemoglobin levels being found in the patients with most advanced cancer and compromised performance status. Hemoglobin concentration differed by tumor site and was lowest in patients with ovarian cancer. Hemoglobin concentration was inversely correlated with inflammatory markers, hepcidin, ferritin, erythropoietin and reactive oxygen species, and positively correlated with leptin, albumin, cholesterol and antioxidant enzymes. In multivariate analysis, stage, interleukin-6 and leptin were independent predictors of hemoglobin concentration. Furthermore, hemoglobin was inversely dependent on modified Glasgow Prognostic Score. In conclusion, cancer-related anemia is a multifactorial problem with immune, nutritional and metabolic components that affect its severity. Only a detailed assessment of the pathogenesis of cancer-related anemia may enable clinicians to provide safe and effective individualized treatment.
肿瘤患者的贫血通常被认为是癌症治疗的副作用；然而，它可能在任何抗肿瘤治疗之前就已出现（癌症相关贫血）。本研究旨在评估一大群肿瘤患者中癌症相关贫血的患病率，以及炎症和营养不良是否可预测其发生和严重程度。本研究纳入了2011年5月至2014年1月期间888例不同部位癌症患者。患者在任何癌症治疗前的诊断时接受评估。分析了根据主要临床因素（肿瘤部位、分期和体能状态）的贫血患病率。对每位患者的炎症、铁代谢、营养不良和氧化应激标志物以及改良格拉斯哥预后评分（一种营养不良和炎症的综合指标）进行评估，并评估它们在预测血红蛋白水平中的作用。贫血患者的比例为63%，血红蛋白水平最低的患者是癌症最晚期且体能状态较差的患者。血红蛋白浓度因肿瘤部位而异，在卵巢癌患者中最低。血红蛋白浓度与炎症标志物、铁调素、铁蛋白、促红细胞生成素和活性氧呈负相关，与瘦素、白蛋白、胆固醇和抗氧化酶呈正相关。在多变量分析中，分期、白细胞介素-6和瘦素是血红蛋白浓度的独立预测因素。此外，血红蛋白与改良格拉斯哥预后评分呈负相关。总之，癌症相关贫血是一个多因素问题，涉及免疫、营养和代谢成分，这些成分会影响其严重程度。只有对癌症相关贫血的发病机制进行详细评估，临床医生才能提供安全有效的个体化治疗。
