According to a recent article published in the *International Journal of Radiation Oncology, Biology, Physics,*anemia may indicate poor survival outcomes of patients with early-stage non-small cell lung cancer (NSCLC).

Lung cancer is the leading cause of cancer-related deaths in the United States and Europe. The most common type of lung cancer, NSCLC, is a malignancy that arises from the tissues of the lung. Under most circumstances, NSCLC is not curable. Current treatments include surgery, chemotherapy, and radiation in an attempt to destroy cancer cells or prevent further tumor growth.

A common side effect of chemotherapy is anemia, a condition in which the patient has lower than normal amount of red blood cells. Red blood cells are the cells that transport oxygen throughout the body. When there are too few red blood cells, the tissues of the body do not get enough oxygen; this can cause symptoms of anemia such as weakness, fatigue, shortness of breath, and dizziness. In some cases, chemotherapy causes anemia as it often destroys the red blood cells as well as the cancer.

In many cases, surgery may be the primary treatment of patients with stage I and II NSCLC, and despite optimal surgical procedures, these patients still have a significant risk of recurrence. In this recent study, researchers evaluated previous patients who had been treated with surgery alone to analyze what factors may have contributed to their survival.

Researchers recruited 125 patients who had been treated for stage I and II NSCLC at the University of Maryland Medical Center. Eighty-two of these patients had received surgery alone as their treatment of NSCLC; 63 patients had undergone lobectomies; and 19 patients had surgery to remove a wedge or a segment of their lung. Each patient was analyzed for the following factors: age, sex, tumor cell type, tumor stage, tumor characteristics, the patient’s hemoglobin level, and the type of surgery performed. The focus of the study was to determine relapse-free survival and overall survival rates.

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Results revealed that the average two-year relapse-free survival rate of the entire study population was 66%, with a higher overall survival rate of 76.3%. The median overall survival for the entire group has not yet been determined. After extensive analysis, researchers determined that the only factor that had a significant effective on the patients’ outcome was their hemoglobin level. Patients who had a hemoglobin level less than 12 mg/dl experienced a significantly worse relapse-free survival rate when compared to patients who were not anemic prior to surgery (26.6 months versus 34.9 months). Overall survival rate for those with low hemoglobin levels was also much shorter at 27months versus 42.5 months. When evaluated by stage, researchers noticed that anemic patients had lower survival rates throughout all stages of disease.

Researchers concluded that a worse outcome in terms of relapse-free survival and overall survival rates could be predicted in early-stage NSCLC patients who were treated with surgery alone and had anemia prior to surgery. Previous research speculated that the effect of anemia on the tumor might make the tumor resistant to radiation. However, the authors of this study believe that anemia may be a sign of a more aggressive tumor that is more likely to fail any type of treatment. Patients are encouraged to speak to their physician regarding factors like anemia that may impact their overall outcome.

Reference: Yovino S, Kwok Y, Krasna M, et al. An Association Between Preoperative Anemia and Decreased Survival in Early Stage Non Small Cell Lung Cancer Patients Treated with Surgery Alone. International Journal of Radiation Oncology, Biology, Physics. 2005;62:1438-1443.

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