Raza Uzma, Sheikh Aminuddin, Jamali Shah Nawaz, Turab Mohsin, Zaidi Syeda Amber, Jawaid Haris
Biochemistry, Hamdard University, Karachi, PAK.
Pathology, Hamdard College of Medicine and Dentistry, Hamdard University, Karachi, PAK.
Cureus. 2020 Mar 13;12(3):e7259. doi: 10.7759/cureus.7259.
Objectives The primary objective of this study was to determine post-treatment variations in the hematological profile of stage 2 breast cancer patients and investigate the influence of disease stage and treatment pattern on these changes. The secondary objective was to evaluate the role of post-treatment hemoglobin as a predictor of disease-free survival. Methods This prospective, observational study included 177 stage 2, female, breast cancer patients. Treatment included surgery, chemotherapy, radiotherapy, and hormonal (anti-estrogen) therapy. Patients were divided into treatment groups based on their histopathological features. Laboratory investigations, including hemoglobin and complete blood count, were carried out twice, first, at the initial cancer diagnosis and, second, eight weeks after completion of radiotherapy. The patients were followed for a period of four years and their disease-free survival was calculated. Results A significant post-treatment decrease in hemoglobin levels and red blood cell (RBC) count was observed in all patients except hormone receptor-positive disease stage 2A patients treated without chemotherapy. Total leukocyte counts were significantly decreased in all hormone receptor-negative patients, and significant neutropenia was observed in all stage 2 patients who received chemotherapy. The severity of anemia was observed to be significantly lower in stage 2A patients (without lymph node metastasis) as compared to stage 2B patients (with lymph node metastasis). Furthermore, no anemia was observed in hormone receptor-positive patients treated without chemotherapy, while moderate anemia was observed in hormone receptor-negative patients who received both pre and post-surgical chemotherapy. The post-treatment hemoglobin levels were found to be a significant predictor of disease-free survival in hormone receptor-positive patients (HR = 0.140, p= 0.000) and in patients of all disease stages except stage 2B (T3 N1 M0). Conclusion The incidence and severity of post-treatment anemia are low in patients treated with hormonal therapy and high in patients with lymph node metastasis. Higher post-treatment hemoglobin levels predict a longer duration of disease-free survival in hormone receptor-positive patients of disease stages 2A and 2B (T2).
目的 本研究的主要目的是确定2期乳腺癌患者治疗后的血液学指标变化，并研究疾病分期和治疗模式对这些变化的影响。次要目的是评估治疗后血红蛋白作为无病生存预测指标的作用。方法 这项前瞻性观察性研究纳入了177例2期女性乳腺癌患者。治疗包括手术、化疗、放疗和激素（抗雌激素）治疗。根据组织病理学特征将患者分为治疗组。实验室检查，包括血红蛋白和全血细胞计数，进行了两次，第一次在癌症初诊时，第二次在放疗结束后8周。对患者进行了4年的随访，并计算了他们的无病生存期。结果 除未接受化疗的激素受体阳性2A期疾病患者外，所有患者治疗后血红蛋白水平和红细胞（RBC）计数均显著下降。所有激素受体阴性患者的白细胞总数均显著下降，所有接受化疗的2期患者均出现显著的中性粒细胞减少。与2B期患者（有淋巴结转移）相比，2A期患者（无淋巴结转移）的贫血严重程度明显较低。此外，未接受化疗的激素受体阳性患者未观察到贫血，而接受手术前后化疗的激素受体阴性患者观察到中度贫血。发现治疗后血红蛋白水平是激素受体阳性患者（HR = 0.140，p = 0.000）以及除2B期（T3 N1 M0）外所有疾病分期患者无病生存的重要预测指标。结论 接受激素治疗的患者治疗后贫血的发生率和严重程度较低，有淋巴结转移的患者则较高。治疗后较高的血红蛋白水平预示着2A期和2B期（T2）激素受体阳性疾病患者的无病生存期更长。
