The Impact Of Chemotherapy-associated Hemoglobin On Prognosis Of Colorectal Cancer Receiving Adjuvant Chemotherapy

Background and ObjectiveAnemia plays an important role in tumor progression.Adjuvant chemotherapy isone of the most important treatment of colorectal cancer (CRC). However, the impactof chemotherapy-associated hemoglobin (Hb) variation on the prognosis of adjuvantchemotherapy is unknown. Here, we aimed to explore the impact ofchemotherapy-associated Hb on prognosis of adjuvant chemotherapy in colorectalcancer (CRC) and propose the best cut-off of chemotherapy-associated Hb affectingDFS, OS.MethodsFrom March2003to March2012,320stage II and III CRC patients receivingadjuvant FOLFOX chemotherapy were enrolled in this retrospective study. Theassociations between chemotherapy-associated Hb and disease free survival(DFS)/overall survival (OS) of CRC, and the best cut-offs of chemotherapy-associatedHb affecting DFS/OS were investigated.Results1．ROC analysis showed the significance between chemotherapy-associated Hband DFS (AUC=0.603, P=0.004), OS (AUC=0.584, P=0.030), with an optimizedcut-off of89.5g/L for DFS,90.5g/L for OS, respectively. However, no association ofchemotherapy-associated Hb decline and DFS (AUC=0.538, P=0.286), OS (AUC= 0.525, P=0.522) was found.2．Kaplan–Meier method showed chemotherapy-associated Hb<89.5g/L wasassociated with shorter DFS (P<0.0001), whereas chemotherapy-associatedHb<90.5g/L was associated with shorter OS (P <0.0001).3．Cox regression model showed chemotherapy-associated Hb <89.5g/L (HR,2.47;95%CI=1.54-3.96) was the independent prognostic factor for DFS, andchemotherapy-associated Hb <90.5g/L (HR,2.26;95%CI=1.35-3.78) was theindependent prognostic factor for OS.4．Multivariate logistic regression model showed the right hemicoloncarcinoma(OR,2.078;95%CI=1.014-4.257)was he independent risk factor forchemotherapy-associated89.5g/L;pretreatment CEA>10ng/ml(OR,2.197;95%CI=1.166-4.412) was the independent risk factor forchemotherapy-associated Hb <90.5g/L.Conclusions1．Chemotherapy-associated Hb<89.5g/L/90.5g/L has a significant impact onthe prognosis of CRC receiving adjuvant chemotherapy. The cut-offs of89.5g/L and90.5g/L may have clinical significance in individualized adjuvant chemotherapytreatment in CRC.2．The right hemicolon carcinoma and Pretreatment CEA>10ng/ml is theindependent predictive factor for cut-offs of Hb during adjuvant chemotherapy ofCRC.