Shamdas G J, Ahmann F R, Matzner M B, Ritchie J M
Department of Medicine, University of Arizona College of Medicine, Tucson.
Cancer. 1993 Jun 1;71(11):3594-600. doi: 10.1002/1097-0142(19930601)71:11<3594::aid-cncr2820711121>3.0.co;2-o.
The clinical and prognostic significance of leukoerythroblastic anemia (LKEA) in patients with metastatic prostate cancer and, in general, patients with disseminated solid tumors is poorly understood. Therefore, the authors studied a population of patients with metastatic prostate cancer refractory to hormonal therapy to assess the incidence, clinical features, and prognostic implications of LKEA.
The medical records of 106 patients with hormone-refractory prostate cancer metastatic to bone seen at the Tucson Veterans Affairs Medical Center between 1985 and 1991 were reviewed retrospectively. The clinical and laboratory data, number of packed erythrocyte transfusions required, and length of survival from the time of diagnosis of hormone-refractory disease until last follow-up visit or death were investigated in 91 identified patients.
Twenty-six of 91 patients (28.6%) were found to have LKEA. LKEA developed before or at the time of diagnosis of hormone-refractory disease in 8 patients and after diagnosis of hormone-refractory disease in 18 patients. The presence of LKEA was associated with significantly lower hemoglobin levels and platelet (Plt) counts and significantly higher total bilirubin, lactic dehydrogenase (LDH), and alkaline phosphatase values (P < 0.05). Leukopenia (< 4.0 x 10(9)/l leukocytes), thrombocytopenia (< 150 x 10(9)/l Plt), elevated LDH levels (> 220 U/l), and laboratory evidence of disseminated intravascular coagulation (DIC) were more common in patients with LKEA than in those without LKEA (P < 0.01). Microangiopathic hemolysis was seen in only 2 of 91 patients (2.1%). Patients with LKEA had significantly greater transfusion requirements compared with patients without LKEA (P < 0.0001), but the median survival length was not significantly different (9 months versus 11 months, respectively). The presence of DIC and LDH levels of 500 U/l or greater in patients with LKEA was associated with a poor prognosis.
LKEA is a relatively common finding in patients with hormone-refractory metastatic prostate cancer and is associated with greater transfusion requirements. Its presence, however, does not affect survival significantly.
白细胞红细胞增多性贫血（LKEA）在转移性前列腺癌患者以及一般实体瘤播散患者中的临床及预后意义尚未完全明确。因此，作者对一组激素难治性转移性前列腺癌患者进行研究，以评估LKEA的发生率、临床特征及预后影响。
回顾性分析1985年至1991年间在图森退伍军人事务医疗中心就诊的106例激素难治性前列腺癌骨转移患者的病历。对91例确诊患者的临床及实验室数据、所需红细胞输注次数以及从激素难治性疾病诊断至最后一次随访或死亡的生存时间进行调查。
91例患者中有26例（28.6%）被发现患有LKEA。8例患者在激素难治性疾病诊断之前或之时出现LKEA，18例患者在激素难治性疾病诊断之后出现LKEA。LKEA的存在与血红蛋白水平和血小板（Plt）计数显著降低以及总胆红素、乳酸脱氢酶（LDH）和碱性磷酸酶值显著升高相关（P<0.05）。白细胞减少（白细胞<4.0×10⁹/L）、血小板减少（Plt<150×10⁹/L）、LDH水平升高（>220 U/L）以及弥散性血管内凝血（DIC）的实验室证据在LKEA患者中比无LKEA患者更常见（P<0.01）。微血管病性溶血仅在91例患者中的2例（2.1%）中出现。与无LKEA患者相比，LKEA患者的输血需求显著更高（P<0.0001），但中位生存长度无显著差异（分别为9个月和11个月）。LKEA患者中DIC的存在以及LDH水平≥500 U/L与预后不良相关。
LKEA在激素难治性转移性前列腺癌患者中是相对常见的发现，且与更高的输血需求相关。然而，其存在对生存无显著影响。
