Open AccessImpact of hemoglobin level on survival in definitive chemoradiotherapy for T4/M1 lymph node esophageal cancer
Author(s) -
Zenda S.,
Hironaka S.,
Boku N.,
Yamazaki K.,
Yasui H.,
Fukutomi A.,
Yoshino T.,
Onozawa Y.,
Nishimura T.
Publication year - 2008
Publication title -
diseases of the esophagus
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 63
eISSN - 1442-2050
pISSN - 1120-8694
DOI - 10.1111/j.1442-2050.2007.00750.x
Subject(s) - medicine , chemoradiotherapy , esophageal cancer , gastroenterology , regimen , univariate analysis , esophagus , lymph node , radiation therapy , fluorouracil , cisplatin , survival rate , chemotherapy , surgery , cancer , multivariate analysis
SUMMARY. We retrospectively investigated the impact of the pre‐chemoradiotherapy hemoglobin level (pre‐CRT Hb level) for T4 and/or M1 lymph node (LYM) squamous cell carcinoma of the esophagus. Chemotherapy consisted of protracted infusion with 5‐fluorouracil (5‐FU) at 400 mg/m 2 /day on days 1–5 and 8–12, combined with cisplatin at 40 mg/m 2 /day on days 1 and 8, repeated twice at a 5‐week interval. Concurrent radiation therapy was started on day 1 and delivered at 2 Gy/day for five days a week for a total radiation dose of 60 Gy, with a two‐week break after a cumulative dose of 30 Gy. Several factors considered to be related with treatment outcome were evaluated by univariate and multivariate analysis. A total of 48 patients with T4/M1 LYM (lymphocyte) esophageal cancer treated with chemoradiotherapy (CRT) between September 2002 and April 2005 were enrolled. The complete response rate to this regimen was 44% and median survival time was 13.6 months, with a median follow‐up period of 26.8 months. Median pre‐CRT Hb level was 13.5 (10.4–15.3) g/dL. The CR rate in patients with a pre‐CRT Hb level of 13 g/dL or less was only 24% but it was 60% in those with a level that was more than 13 g/dL ( P =0.01). As for survival, anova revealed that a pre‐CRT Hb of 13 g/dL or less was a significant prognostic factor with a hazard ratio of 0.45 (95% confidence interval [CI]); 0.21–0.97, P =0.04), while on manova , including performance status, tumor size, TNM stage and pre‐CRT Hb level, a pre‐CRT Hb level of 13 g/dL or less was the only significant prognostic factor, with a hazard ratio of 0.35 (95% CI; 0.13–0.90, P =0.03). In conclusion, the pre‐CRT Hb level may be an important determinant of outcome in patients with T4/M1 LYM squamous cell carcinoma of the esophagus.