化疗相关血红蛋白对接受辅助化疗的结直肠癌患者预后的影响。
The impact of chemotherapy-associated hemoglobin on prognosis of colorectal cancer patients receiving adjuvant chemotherapy.
机构信息
Department of Gastrointestinal Surgery, Lab of Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong, China.
Sino-French Hoffmann Institute, Guangzhou Medical University, Guangzhou 511436, Guangdong, China.
出版信息
Cancer Biomark. 2017 Dec 6;20(4):627-635. doi: 10.3233/CBM-170601.
BACKGROUND AND OBJECTIVE
The association of chemotherapy-associated hemoglobin and survival of colorectal cancer (CRC) receiving adjuvant chemotherapy is uncertain. We sought to explore the prognostic value of chemotherapy-associated hemoglobin in CRC receiving adjuvant chemotherapy and the best cut point affecting prognosis.
METHODS
Three hundred and twenty stage II and III CRC patients receiving adjuvant FOLFOX chemotherapy from March 2003 to March 2012 were enrolled. The associations between chemotherapy-associated hemoglobin (the absolute levels of post-chemotherapy) or chemotherapy-associated hemoglobin change (change between the pre- and post-chemotherapy hemoglobins) and disease free survival (DFS) or overall survival (OS) of CRC, and the best cut point were investigated.
RESULTS
Log rank test showed the best cut points for chemotherapy-associated hemoglobin and chemotherapy-associated hemoglobin change were respectively 90 g/L, 30 g/L. Cox regression model showed chemotherapy-associated hemoglobin < 90 g/L was the independent prognostic factor for DFS (HR, 2.221; 95% CI = 1.157-4.262), OS (HR, 2.058; 95% CI = 1.009-4.197), respectively, but no association of chemotherapy-associated hemoglobin change ⩾ 30g/L and DFS (HR, 2.063; 95% CI = 0.929-4.583), OS (HR, 1.386; 95% CI = 0.553-3.471) was found.
CONCLUSIONS
Chemotherapy-associated hemoglobin < 90 g/L has a significant prognostic value in CRC receiving adjuvant chemotherapy, which is a significant biomarker in the individualized management and may suggest the simple indication for the treatment of anemia in adjuvant chemotherapy in CRC.
背景与目的
化疗相关血红蛋白与接受辅助化疗的结直肠癌（CRC）患者生存的相关性尚不确定。我们旨在探讨接受辅助 FOLFOX 化疗的 CRC 患者化疗相关血红蛋白对预后的预测价值，以及影响预后的最佳截断值。
方法
本研究纳入了 2003 年 3 月至 2012 年 3 月期间接受辅助 FOLFOX 化疗的 320 例 II 期和 III 期 CRC 患者。分析了化疗相关血红蛋白（化疗后绝对水平）或化疗相关血红蛋白变化（化疗前后血红蛋白变化）与 CRC 无病生存（DFS）或总生存（OS）的关系，并确定最佳截断值。
结果
Log-rank 检验显示，化疗相关血红蛋白和化疗相关血红蛋白变化的最佳截断值分别为 90 g/L 和 30 g/L。Cox 回归模型显示，化疗相关血红蛋白<90 g/L 是 DFS（HR，2.221；95%CI=1.157-4.262）和 OS（HR，2.058；95%CI=1.009-4.197）的独立预后因素，而化疗相关血红蛋白变化≥30 g/L 与 DFS（HR，2.063；95%CI=0.929-4.583）和 OS（HR，1.386；95%CI=0.553-3.471）无显著相关性。
结论
化疗相关血红蛋白<90 g/L 在接受辅助化疗的 CRC 患者中具有显著的预后价值，是一个重要的生物标志物，可用于指导辅助化疗中 CRC 患者的个体化管理，也可能提示辅助化疗中治疗贫血的简单适应证。
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