Abstract
Hemoglobin (Hb) levels are reportedly related with treatment outcomes and survival in patients of breast cancer. However, the long-term change in Hb levels after treatment and the effects of Hb on survival remain unknown. This retrospective cohort study enrolled 1931 breast cancer patients with pathological stage I-IV between 1/1/2003 and 12/31/2013. Latent class modeling was used to identify trajectories in monthly Hb levels over time. The primary endpoint was 10-year cancer-related death. We identified 5 distinct Hb trajectories: persistent anemia (5.6 %; n = 109), improved anemia (4.8 %, n = 93), mild anemia (21.0%; n = 406), low normal Hb (46.6 %; n = 899), and normal Hb (21.9%; n = 424). Compared with the normal-Hb group, trajectories with low Hb levels had worst 10-year survival. The adjusted hazard ratios were 1.79(95% CI, 0.91-3.53) for the improved anemia group, 1.09(95% CI, 0.68-1.74) for the mild anemia group, 1.06 (95% CI, 0.71-1.60) for the low normal Hb group, and 2.19(95% CI 1.28-3.75) for the persistent anemia group. Our findings show there are five Hb level trajectories during breast cancer treatment. The anemia Hb level trajectory during the first 12 months after treatment reflect the worst cancer-related 10-year survival in breast cancer patients.
Highlights
The incidence of anemia in patients with solid tumors is reportedly 2–78% [1]
The persisted anemia group were significantly associated with worst 10-year survival compared with the normal Hb trajectory groups (Hb threshold of approximately 12-14 g/ dL) in breast cancer patients
It is notable that most Hb levels declined in the first 6 months after treatment initiation, but the Hb level continued to increase after treatment in the improved anemia trajectory
Summary
The incidence of anemia in patients with solid tumors is reportedly 2–78% [1]. The causes of anemia in cancer patients are multifactorial, including chemotherapy and radiation-induced myelosuppression, bleeding, marrow infiltration by cancer invasion, nutritional deficiencies, and cytokine-mediated anemia. Hemoglobin (Hb) levels are related with treatment outcomes and survival in patients with various cancers [2,3,4,5,6,7,8]. There are few studies that have focused on pre-treatment Hb levels for breast cancer prognosis [9,10,11,12,13]. The Hb level might change after treatment (chemotherapy, radiation therapy, or surgery) or with different cancer stages. The long-term effects of Hb on survival after treatment remain unknown
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