The impact of preoperative anaemia and anaemic subtype on patient outcome in colorectal cancer

Abstract

Preoperative anaemia, especially microcytic anaemia, was associated with poor patient outcomes, possibly due to poor systemic inflammatory and nutritional status, and it was not improved by perioperative blood transfusion. Our data suggest that preoperative anaemia and the anaemic subtype may serve as an easily available predictor of outcome in CRC.

Quantitative data on red cell measures of iron status and their relation to the magnitude of the systemic inflammatory response and survival in patients with colorectal cancer

“…Inflammation associated normocytic anaemia has been reported to be associated with poorer outcomes than classical microcytic anaemia of blood loss in several cohorts [4]. Unlike the previous studies [4][5]8], multivariate survival analysis in the present cohort did not find normocytic anaemia to be independently prognostic. This is possibly due to the significant co-dependent relationship between Hb and normocytic anaemia, and the fact that a continuous variable was compared to a binary categorical variable.…”

“…In addition, there are commonly measured parameters of the circulating erythrocyte population such as haemoglobin (Hb), mean corpuscular volume (MCV) mean corpuscular haemoglobin (MCH) and red cell distribution width (RDW) [7]. These variables may reflect iron status but are also recognised to be influenced by systemic inflammation [8].…”

Oxaliplatin-induced haematological toxicity and splenomegaly in mice

“…An exception is the CRLM patient group, where splenomegaly is associated with the occurrence of SOS and is proposed as a biomarker for increased occurrence of post-operative complications [7]. There is now evidence that pre-treatment anaemia and post-treatment splenomegaly in CRC patients may have a physiological impact on patient outcome and cancer progression [4,15,23]. Whilst some form of spleen enlargement is known to occur in >90% of patients [6], the mechanisms involved could have important implications regarding the anti-tumour activity of oxaliplatin and potential combination of this chemotherapeutic with immunotherapies, given the critical role of the immune system in tumour suppression.…”

“…Addition of oxaliplatin to fluorouracil and leucovorin for the treatment of CRC patients causes a significant increase in all grade anaemia when compared to fluorouracil and leucovorin treatment alone [1]. CRC patients also often have pre-operative cancer-related anaemia [3], which is reported to be a factor in poor disease progression and recovery [4]. Generally, however, anaemia is relatively mild with most patients experiencing grade 1-2 and only a small percentage of patients experiencing grade 3-4 [1].…”

Association of inflammatory status of patients with histopathological characteristics of colorectal tumors and perioperative transfusion requirements

“…The microcytic anemia, in particular, is strongly associated with the greater depth of tumor invasion (P = 0.0072) and higher mGPS (P = 0.0058) than other causes of anemia. Perioperative blood transfusion for CRC patients with anemia correlates with adverse outcomes (15). Hypoalbuminemia is also a risk factor for perioperative transfusion and survival of patients who had a liver resection (16).…”