Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
Oral Oncol. 2022 Oct;133:106054. doi: 10.1016/j.oraloncology.2022.106054. Epub 2022 Aug 5.
We sought to define the optimal threshold for anemia in North American head and neck cancer patients and evaluate its role as a prognostic biomarker.
A single-institution database was queried for patients with head and neck cancer who underwent chemoradiation from January 2005 to April 2021. An optimal threshold of hemoglobin (Hgb) level was defined based on maximum log-rank test statistic. Cox multivariable analysis (MVA), Kaplan-Meier, and propensity score matching were performed to evaluate treatment outcomes.
A total of 496 patients were identified. Threshold for Hgb was determined to be 11.4 for both overall survival (OS) and progression-free survival (PFS). Low Hgb was associated with worse OS (adjusted hazards ratio [aHR] 2.41, 95 % confidence interval [CI] 1.53-3.80, p < 0.001) and PFS (aHR 2.01, 95 % CI 1.30-3.11, p = 0.002). Similar findings were observed among 39 matched pairs for OS (5-year OS 22.3 % vs 49.0 %; HR 2.22, 95 % CI 1.23-4.03, p = 0.008) and PFS (5-year PFS 24.3 % vs 39.1 %; HR 1.78, 95 % CI 1.02-3.12, p = 0.04). Among those with HPV-negative tumors, low Hgb was associated with worse OS (aHR 13.90, 95 % CI 4.66-41.44, p < 0.001) and PFS (aHR 5.24, 95 % CI 2.09-13.18, p < 0.001). However, among those with HPV-positive tumors, low Hgb was not associated with both OS (aHR 1.75, 95 % CI 0.60-5.09, p = 0.31) and PFS (aHR 1.13, 95 % CI 0.41-3.14, p = 0.82).
Low Hgb below 11.4 was an independent adverse prognostic factor for worse survival. It was also prognostic among patients with HPV-negative tumors, but not for HPV-positive tumors.
我们旨在确定北美头颈部癌症患者贫血的最佳阈值，并评估其作为预后生物标志物的作用。
对 2005 年 1 月至 2021 年 4 月接受放化疗的头颈部癌症患者的单机构数据库进行了查询。基于最大对数秩检验统计量确定血红蛋白（Hgb）水平的最佳阈值。进行 Cox 多变量分析（MVA）、Kaplan-Meier 分析和倾向评分匹配，以评估治疗结果。
共纳入 496 例患者。确定 Hgb 的阈值为 11.4，用于总生存（OS）和无进展生存（PFS）。低 Hgb 与较差的 OS（校正风险比[HR] 2.41，95%置信区间[CI] 1.53-3.80，p<0.001）和 PFS（HR 2.01，95%CI 1.30-3.11，p=0.002）相关。在 OS 中，39 对匹配的患者中也观察到了类似的发现（5 年 OS 为 22.3%vs 49.0%；HR 2.22，95%CI 1.23-4.03，p=0.008）和 PFS（5 年 PFS 为 24.3%vs 39.1%；HR 1.78，95%CI 1.02-3.12，p=0.04）。在 HPV 阴性肿瘤患者中，低 Hgb 与较差的 OS（HR 13.90，95%CI 4.66-41.44，p<0.001）和 PFS（HR 5.24，95%CI 2.09-13.18，p<0.001）相关。然而，在 HPV 阳性肿瘤患者中，低 Hgb 与 OS（HR 1.75，95%CI 0.60-5.09，p=0.31）和 PFS（HR 1.13，95%CI 0.41-3.14，p=0.82）均无关。
低于 11.4 的低 Hgb 是生存较差的独立不良预后因素。它在 HPV 阴性肿瘤患者中也是预后因素，但在 HPV 阳性肿瘤患者中不是。
