Abstract
BackgroundHypoxia seems to be an influencing factor for oral squamous cell carcinomas (SCC), and several immunohistochemical markers have been discussed in this regard. The aim of the present study was to evaluate preoperative hemoglobin levels as a prognostic factor for oral SCC.Materials and methodsThe files of 287 patients who had been treated for oral SCC between 1999 and 2008 were studied retrospectively. Hemoglobin levels between 1 and 5 days prior to surgical treatment were compared to Tumor (T)- and Nodal (N)- status, local recurrence, and lymph node metastases rate. The minimum follow-up period was 12 months.ResultsFrom a total of 287 patients with oral SCC, 205 (71.4%) were in the normal hemoglobin (Hb) group (female Hb≥12.0 g/dl; male Hb≥13.0 g/dl), 53 (18.5%) in the mild anemia (female Hb = 11.0-11.9 g/dl; male Hb = 11.0-12.9 g/dl), and 29 (10.1%) in the severe anemia group (female & male Hb<11.0 g/dl). Anemia was significant for the development of lymph node metastasis (p = 0.005) as well as for local recurrence (p = 0.001). No significant correlation was found to the initial T status (p = 0.183).ConclusionOur data suggests that an Hb of below 11 g/dl contributes to and is an indicator for a poor prognosis. Consequently, pre-treatment Hb corrections may significantly improve outcome, but further investigations, including blood transfusion/application of erythropoietin due to tumor anemia, independent of intraoperative blood-loss are necessary to ascertain their role in an improved survival.
Highlights
Hypoxia seems to be an influencing factor for oral squamous cell carcinomas (SCC), and several immunohistochemical markers have been discussed in this regard
Our data suggests that an Hb of below 11 g/dl contributes to and is an indicator for a poor prognosis
Pre-treatment Hb corrections may significantly improve outcome, but further investigations, including blood transfusion/application of erythropoietin due to tumor anemia, independent of intraoperative blood-loss are necessary to ascertain their role in an improved survival
Summary
Hypoxia seems to be an influencing factor for oral squamous cell carcinomas (SCC), and several immunohistochemical markers have been discussed in this regard. Chemotherapy, radiotherapy, and improved surgical techniques, the 5-year survival rate for head and neck cancer seems to be unchanged over the last two decades. Clinical features and progression can differ greatly: some tumors develop no metastases, while others infiltrate at a very early stage and develop lymphangiomatosis or perineural invasion; such complications are not limited to well known risk factors such as smoking, Hypoxia seems to be an influencing factor for oral squamous cell carcinomas (SCC), and it is well known that the radiation doses needed to kill hypoxic cells are approximately 2-3 times higher than those needed to destroy well-oxygenated cells[3,4]. Most studies for head and neck SCC, deal with the effect of anemia as it relates to the outcome of radiotherapy[5,6]. We have come across no studies which have dealt with this subject
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