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Annals of Oncology Advance Access published online on September 12, 2006
Annals of Oncology, doi:10.1093/annonc/mdl285
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© 2006 European Society for Medical Oncology
Received February 1, 2006
Revised July 1, 2006
Accepted July 3, 2006

original article

Anemia may influence the outcome of patients undergoing neo-adjuvant treatment of rectal cancer

R. Berardi 1 *, C. Braconi 1, G. Mantello 1, M. Scartozzi 1, S. Del Prete 1, G. Luppi 2, R. Martinelli 3, M. Fumagalli 3, G. Valeri 4, I. Bearzi 5, C. Marmovale 6, F. Grillö-Ruggieri 1, and S. Cascinu 1

1 Department of Oncology and Radiotherapy, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I--GM Lancisi--G Salesi di Ancona, Italy
2 Radiotherapy, Università di Modena, Italy
3 Radiotherapy, Università di Parma, Italy
4 U.O. di Anatomia Patologica, Università Politecnica delle Marche
5 Department of Radiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I--GM Lancisi--G Salesi di Ancona, Italy
6 Clinica di Chirurgia Generale, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I--GM Lancisi--G Salesi di Ancona, Italy

* To whom correspondence should be addressed.
R. Berardi, E-mail: r.berardi{at}univpm.it


  Abstract

Background: We hypothesized that anemia could represent one of the major factors influencing the outcome of patients undergoing neo-adjuvant treatment of rectal cancer.

Patients and methods: This analysis included all the consecutive patients who underwent neo-adjuvant treatment (chemotherapy and/or radiotherapy) before surgery for rectal cancer in three oncology/radiotherapy departments from June 1996 to December 2003.

Results: Three hundred and seventeen patients were eligible for our analysis. Median age at diagnosis was 64 years (range 26-88 years); male/female ratio was 184/133. Two hundred and eighty-five patients (89.9%) were diagnosed with adenocarcinoma, while 32/317 (10.1%) with mucinous adenocarcinoma. Neo-adjuvant treatments carried out were as follows: radiotherapy alone in 75/317 patients (23.7%), radiotherapy plus chemotherapy in 242/317 patients (76.3%). At univariate and multivariate analysis, only the hemoglobin (Hb) level (group 1: ≤12 g/dl versus group 2: >12 g/dl) resulted in a significant factor for disease-free survival. The role of the Hb level seemed to be confirmed further by the clinical downstaging obtained in ~55% of patients in group 2, in comparison with 35% of the patients achieving a significant downstaging in group 1.

Conclusion: Our results indicated that anemia could represent an important parameter able to influence the outcome in patients receiving neo-adjuvant treatment of rectal cancer.

Keywords: rectal cancer; anemia; prognostic factors.
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