Abstract
BackgroundMany studies have reported the prognostic value of haemoglobin level for cancers. Whereas the prognostic impact of decreased pretreatment haemoglobin level on the survival of patients with lung cancer remains controversial, herein, a systematic review and meta-analysis were conducted to investigate whether a decreased haemoglobin level before treatment is a significant predictor of survival in patients with lung cancer.MethodsWe performed a systematic review and meta-analysis of observational studies to evaluate the prognostic impact of a decreased haemoglobin level on the survival of patients with lung cancer. Relevant studies were retrieved from databases including PubMed, Embase, Web of Science and the Cochrane Library. Reference lists were hand-searched for potentially eligible studies. The Newcastle-Ottawa scale was used to assess the quality of included studies. Observational studies were included if they provided sufficient information for the extraction of the pooled hazard ratios (HR) and 95% confidence intervals (95% CI) for overall survival, disease-free survival, relapse-free survival, progression-free survival, event-free survival and time to progression. Subgroup analysis, meta-regression and sensitivity analyses were applied to explain the heterogeneity.ResultsFifty-five articles involving a total of 22,719 patients were obtained to evaluate the correlation between haemoglobin level and survival. The results indicated that decreased haemoglobin level was significantly associated with poor overall survival of patients with lung cancer (HR 1.51, 95% CI 1.42–1.61), both in non-small cell lung cancer (HR 1.57, 95% CI 1.44–1.72) and in small cell lung cancer (HR 1.56, 95% CI 1.21–2.02). We also found that the lower the haemoglobin level, the shorter was the overall survival of patients with lung cancer (HR 1.11, 95% CI 1.06–1.16). However, the relationship between decreased haemoglobin and relapse-free survival was not significant (HR 1.37, 95% CI 0.91–2.05).ConclusionA decreased pretreatment haemoglobin level among patients with lung cancer is a prognostic factor of poor survival that can serve as an important indicator in survival prediction, risk stratification and treatment selection. In clinical practice, more attention should be paid to monitoring pretreatment haemoglobin levels among patients with lung cancer.
Highlights
Many studies have reported the prognostic value of haemoglobin level for cancers
Some studies showed that overall survival (OS) was significantly shorter in lung cancer patients with a low Hb level before treatment [11, 12], while some showed that the correlation between low Hb level and shorter OS was not significant [13, 14]
There appeared to be no heterogeneity among hazard ratios (HR) (I2 = 0.0%, p = 0.517), and we found that decreased Hb was a negative prognostic factor for OS (HR 1.45, 95% confidence interval (CI) 1.29–1.63)
Summary
Many studies have reported the prognostic value of haemoglobin level for cancers. Integrated treatment strategies and multidisciplinary nursing interventions based on surgery, radiotherapy and chemotherapy have provided improvements in the survival of patients with lung cancer, more effective prognostic factors should be identified to guide therapy and assess disease progression in individuals. The prognostic value of Hb level in patients with lung cancer has not been well confirmed. Some studies showed that overall survival (OS) was significantly shorter in lung cancer patients with a low Hb level before treatment [11, 12], while some showed that the correlation between low Hb level and shorter OS was not significant [13, 14]. In this study, a meta-analysis was conducted to determine the prognostic value of decreased Hb level in patients with lung cancer
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