T4 stage and preoperative anemia as prognostic factors for the patients with colon cancer treated with adjuvant FOLFOX chemotherapy

An, Min Sung; Yoo, Jong Han; Kim, Kwang Hee; Bae, Ki Beom; Choi, Chang Soo; Hwang, Jin Won; Kim, Ji Hyun; Kim, Bo Mi; Kang, Mi Seon; Oh, Min Jun; Hong, Kwan Hee

doi:10.1186/s12957-015-0488-7

Cited by 28 publications

(25 citation statements)

References 23 publications

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“…The earlier studies on the prognostic significance of blood Hb levels in CRC have been controversial, with reports of the association of anemia with lower survival in advanced colorectal cancer 9 , lower OS in stage II-III CRC treated with FOLFOX chemotherapy 10 , lower OS in stage I-III CRC 13 , no independent prognostic value in stage I-III CRC 14 , adverse OS in metastasized CRC 15 , 19 , poor OS in stage I-III rectal cancer, and no prognostic value in unselected colon cancer material 20 . Moreover, iron deficiency anemia has been associated with diminished disease-free survival in T3N0M0 colon cancer 8 .…”

Section: Discussionmentioning

confidence: 99%

Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival

Väyrynen

Tuomisto

Klintrup

et al. 2018

Sci Rep

108

100

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Anemia is common in colorectal cancer (CRC) but its relationships with tumor characteristics, systemic inflammation, and survival have not been well characterized. In this study, blood hemoglobin levels and erythrocyte mean corpuscular volume (MCV) levels were measured in two independent cohorts of 148 CRC patients and 208 CRC patients, and their correlation with patient and tumor characteristics, systemic inflammatory markers (modified Glasgow Prognostic Score: mGPS; serum levels of thirteen cytokines, C-reactive protein, albumin), and survival were analyzed. We found that anemia, most frequently normocytic, followed by microcytic, was present in 43% of the patients. Microcytic anemia was most commonly associated with proximal colon tumor location. Average MCV and blood hemoglobin levels were lower in tumors with high T-class. Low blood hemoglobin associated with systemic inflammation, including high mGPS and high serum levels of C-reactive protein and IL-8. Particularly, normocytic anemia associated with higher mGPS. Normocytic anemia associated with a tendency towards worse overall survival (multivariate hazard ratio 1.61, 95% confidence interval 1.07–2.42, p = 0.023; borderline statistical significance considering multiple hypothesis testing). In conclusion, anemia in CRC patients is most frequently normocytic. Proximal tumor location is associated with predominantly microcytic anemia and systemic inflammation is associated with normocytic anemia.

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Section: Discussionmentioning

confidence: 99%

Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival

Väyrynen

Tuomisto

Klintrup

et al. 2018

Sci Rep

108

100

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“…Preoperative anaemia is emerging as an important health problem in colorectal cancer patients. Importantly, preoperative anaemia has already been associated with increased short-term postoperative morbidity and mortality (< 30 days) [ 2 , 19 ] and worse colorectal tumour prognosis [ 3 , 4 , 20 ]. Whereas preoperative anaemia is often associated with iron deficiency, up to now, guidelines for the management of cancer or chemotherapy-induced anaemia make only a few remarks on the management of iron deficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative anaemia is frequently observed in colorectal cancer patients, with reported case incidences of > 30% [ 1 ]. Preoperative anaemia generally is associated with increased postoperative morbidity and mortality [ 2 ] and is also reported to be a cause of inferior long-term outcome, possibly by worsening of tumour hypoxia [ 3 , 4 ]. Furthermore, preoperative anaemia is associated with increased utilisation of allogeneic red blood cell (RBC) transfusion, which, for its part, is also associated with deleterious effects on the short- and long-term outcome in colorectal cancer patients [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

The role of preoperative iron deficiency in colorectal cancer patients: prevalence and treatment

Wilson

Dekker

Harlaar

et al. 2017

Int J Colorectal Dis

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BackgroundIn preoperative blood management of colorectal cancer patients, intravenous iron therapy is increasingly used to treat anaemia and prevent red blood cell transfusions. However, while iron deficiency is the most common cause of anaemia, little is known about the prevalence and namely type of iron deficiency in this population, whereas both types of iron deficiency (i.e. absolute and functional iron deficiency) are recommended to be treated differently by international cancer guidelines.ObjectiveThe aim of present study is to investigate the prevalence and namely type of iron deficiency in colorectal cancer patients, and to assess its clinical relevance.MethodsPreoperative iron status, clinical parameters (i.e. age, ASA classification, tumour location, tumour stage) and postoperative complications were retrospectively collected for all newly diagnosed colorectal cancer patients in our institution over a 3-year period.ResultsIron deficiency was observed in 163 (48.1%) of 339 patients. Of these iron-deficient patients, 3.7% had an isolated absolute iron deficiency (AID) and 15.3% a functional iron deficiency (FID), while the rest had a combination of AID and FID. Anaemia was present in 66.1% of iron-deficient patients. Iron deficiency was significantly associated with an increased postoperative complication rate (univariable OR 1.94, p = 0.03, multivariable OR 1.84, p = 0.07), with right-sided tumours (p < 0.001), high ASA classification (p = 0.002), advanced tumour stage (p = 0.01) and advanced age (p = 0.04). In comparing clinical parameters between patients with AID and FID, advanced age was significantly associated with FID (p = 0.03), and the presence of anaemia with AID (p = 0.02).ConclusionIn preoperative colorectal cancer patients, there is a high prevalence of iron deficiency, including a high percentage of patients with—a component of—functional iron deficiency, associated with the increased postoperative complication rate. As both types of iron deficiency require a different treatment strategy, our results illustrate the therapeutic potential of especially intravenous iron supplementation in patients with severe iron deficiency and stress the urgency of routinely monitoring preoperative iron status and differentiation between types of iron deficiency. As iron therapy may also be potentially harmful in respect to stimulation of tumour growth, future clinical trials assessing the long-term effect of iron therapy are necessary.

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“…Moreover, CRA at diagnosis is a negative prognosticator for disease progression, survival ( Obermair et al, 1998 ; Shin et al, 2014 ; Zhang et al, 2014 ; An et al, 2015 ) and overall death risk ( Caro et al, 2001 ). CRA is also an established negative prognosticator for survival in early stage lung, breast, colorectal, and gynecological cancer patients candidate to surgery ( Chamogeorgakis et al, 2008 ; Zhang et al, 2014 ; Cybulska et al, 2017 ).…”

Section: Clinical Relevance Of Cramentioning

confidence: 99%

Pathogenesis and Treatment Options of Cancer Related Anemia: Perspective for a Targeted Mechanism-Based Approach

Gramignano²,

et al. 2018

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Cancer-related anemia (CRA) is a common sign occurring in more than 30% of cancer patients at diagnosis before the initiation of antineoplastic therapy. CRA has a relevant influence on survival, disease progression, treatment efficacy, and the patients’ quality of life. It is more often detected in patients with advanced stage disease, where it represents a specific symptom of the neoplastic disease, as a consequence of chronic inflammation. In fact, CRA is characterized by biological and hematologic features that resemble those described in anemia associated to chronic inflammatory disease. Proinflammatory cytokine, mainly IL-6, which are released by both tumor and immune cells, play a pivotal action in CRA etiopathogenesis: they promote alterations in erythroid progenitor proliferation, erythropoietin (EPO) production, survival of circulating erythrocytes, iron balance, redox status, and energy metabolism, all of which can lead to anemia. The discovery of hepcidin allowed a greater knowledge of the relationships between immune cells, iron metabolism, and anemia in chronic inflammatory diseases. Additionally, chronic inflammation influences a compromised nutritional status, which in turn might induce or contribute to CRA. In the present review we examine the multifactorial pathogenesis of CRA discussing the main and novel mechanisms by which immune, nutritional, and metabolic components affect its onset and severity. Moreover, we analyze the status of the art and the perspective for the treatment of CRA. Notably, despite the high incidence and clinical relevance of CRA, controlled clinical studies testing the most appropriate treatment for CRA are scarce, and its management in clinical practice remains challenging. The present review may be useful to indicate the development of an effective approach based on a detailed assessment of all factors potentially involved in the pathogenesis of CRA. This mechanism-based approach is essential for clinicians to plan a safe, targeted, and successful therapy, thereby promoting a relevant amelioration of patients’ quality of life.

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T4 stage and preoperative anemia as prognostic factors for the patients with colon cancer treated with adjuvant FOLFOX chemotherapy

Cited by 28 publications

References 23 publications

Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival

Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival

The role of preoperative iron deficiency in colorectal cancer patients: prevalence and treatment

Pathogenesis and Treatment Options of Cancer Related Anemia: Perspective for a Targeted Mechanism-Based Approach

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