THE RELATIONSHIP OF PRETREATMENT SERUM HEMOGLOBIN LEVEL TO THE SURVIVAL OF EPITHELIAL OVARIAN-CARCINOMA PATIENTS - A PROSPECTIVE REVIEW

BACKGROUND. Tumor anemia is a common symptom in cancer patients. This study assessed the prognostic relationship of pretreatment serum hemog lobin levels to survival in a retrospective sample of 206 patients wit h epithelial ovarian carcinoma. METHODS. Survival analysis was evaluat ed by univariate (Kaplan-Meier product limit method and log rank test) and multivariate (Cox proportional hazards model) analysis. Mean valu es were compared by the Kruskal-Wallis test. Serum hemoglobin levels w ere determined in each patient 24-48 hours before surgery. Anemia was defined as a serum hemoglobin value below 12 g/dL. RESULTS. Tumor anem ia was present in 32% of the patients before primary surgery. Hemoglob in levels were significantly lower in patients with residual tumor tha n in those with no detectable residual tumor after initial surgery (P = 0.008). Although statistically not significant, we found a trend tow ard lower hemoglobin levels with advanced stage of disease. For 5 year s, overall survival probability was 38.5% and 52.3% for patients with pretreatment hemoglobin levels P = 0.008). In multivariate analysis, t he relative risk of death was significantly associated with decreasing serum hemoglobin levels. No interaction was found between the grade o f anemia and chemotherapy or radiation therapy with respect to its inf luence on overall survival. CONCLUSIONS, After adjustment for establis hed prognostic factors, tumor anemia was found to have an independent relationship to the overall survival of patients with ovarian carcinom a. Because no significant interaction could be found between the grade of anemia and chemotherapy, marked tumor anemia was considered an ind icator of the presence of biologically aggressive tumor cell clones. C ancer 1998;83:726-31. (C) 1998 American Cancer Society.