Iron deficient erythropoiesis might play key role in development of anemia in cancer patients.

Silvia Park,Chul Won Jung,Kihyun Kim,Won Seog Kim,Jun Ho Jang,Seok Jin Kim

doi:10.18632/oncotarget.5658

Silvia Park, Chul Won Jung + Show 4 more

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https://doi.org/10.18632/oncotarget.5658

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Journal: Oncotarget	Publication Date: Oct 26, 2015
Citations: 79	License type: cc-by

Affiliation: Sungkyunkwan University, Samsung Medical Center

Abstract

Multifactorial pathogenesis is involved in anemia of cancer patients and defining the causes of anemia is not always simple. The incidence of anemia among 4 major cancers (gastric, colorectal, lung cancer and hepatocellular carcinoma), and biochemical features of anemia using ferritin, CRP, hepcidin and soluble transferrin receptor (sTfR) were assessed. Anemia was defined either by hemoglobin (Hb) ≤11 g/dL or a drop of Hb 2 g/dL or more during anticancer treatment. Among the 345 patients including 152 lung cancer, 101 gastric cancer, 69 colorectal cancer and 23 hepatocellular carcinoma, 49 patients (14.2%) had anemia at their initial diagnosis of cancer. During treatment, 129 (37.4%) experienced anemia, and 34 (26.4%) were treated mostly by transfusion. Biochemical feature of anemia was examined with 39 patients' samples. When comparing to the reference value from general population, cancer patients showed numerically higher ferritin, sTfR, CRP and hepcidin level. Among the cancer patients, anemic patients had significantly higher ferritin (p = 0.050) and sTfR (p = 0.009) level compared to non-anemic patients. Anemia is a common issue in cancer patients and is largely undertreated with sub-optimal diagnoses of cause. The rates of anemia increase significantly during anti-cancer treatment and appear to be largely associated with iron deficiency.

Highlights

Multifactorial pathogenesis is involved in anemia of cancer patients and defining the causes of anemia is not always simple
Anemia in patients with cancer is understood to have a multifactorial pathogenesis [6,7,8,9,10,11] with the vast majority believed to have some degree anemia of chronic disease (ACD) secondary to their cancer [12], of which functional iron deficiency (FID) plays a key role [13, 14]
Anemia was initially observed in 20.3% of patients with gastric cancer, 13.9% with colorectal cancer, 8.7% with hepatocellular carcinoma (HCC) and 12.5% with lung cancer (p = 0.421)

Summary

Introduction

Multifactorial pathogenesis is involved in anemia of cancer patients and defining the causes of anemia is not always simple. Anemia in patients with cancer is understood to have a multifactorial pathogenesis [6,7,8,9,10,11] with the vast majority believed to have some degree anemia of chronic disease (ACD) secondary to their cancer [12], of which functional iron deficiency (FID) plays a key role [13, 14]. Insufficient iron incorporation into erythroid precursor despite of apparently adequate body iron stores is a major phenomenon of FID [14] and seems to be more frequent than absolute iron deficiency in cancer patients probably due to the underlying inflammation from malignancy [15, 16]. Due to the potentially multifactorial complexity of anemia, defining the causes in cancer patients is not always simple, and conventional evaluation has only limited value [21]

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