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Clinical Trial
. 2003 Sep 15;89(6):977-82.
doi: 10.1038/sj.bjc.6601216.

Pretreatment haemoglobin levels significantly predict the tumour response to primary chemotherapy in human breast cancer

A Bottini  1 , A Berruti, M P Brizzi, A Bersiga, D Generali, G Allevi, S Aguggini, G Bolsi, S Bonardi, G Bertoli, P Alquati, L Dogliotti
Affiliations
Clinical Trial

Pretreatment haemoglobin levels significantly predict the tumour response to primary chemotherapy in human breast cancer

A Bottini et al. Br J Cancer. .

Abstract

The purpose of this study was to evaluate whether tumour response to primary chemotherapy in human breast cancer is influenced by baseline haemoglobin (Hb) status. A total of 157 patients with T2-4, N0-1 M0 breast cancer were treated with chemotherapy consisting of either the CMF regimen + tamoxifen (the first 76 cases) or the single-agent epirubicin (the subsequent 81) before definitive surgery. In total, 144 patients were fully assessable. Ki67, p53, bcl-2, c-erbB2, steroid hormone receptor, and microvessel density were evaluated immunohistochemically in tumour specimens obtained before chemotherapy and at surgery. Tumour shrinkage >50% occurred in 72.1% of patients. Responding patients had higher baseline Hb levels and red blood cell counts than nonresponders (P<0.01 and <0.003, respectively). The distribution of disease response according to increasing cutoffs of baseline Hb status showed that from 12.5 mg l(-1) onwards, patients with Hb levels above the cutoff obtained a greater response rate than those with lower Hb values. The difference attained the statistical significance at 12.5 (76.1 vs 59.5%, P<0.05) and 13.0 g/dl(-1) (81.0 vs 57.6%, P<0.002) cutoffs, respectively. The predictive role of Hb levels was maintained in multivariate analysis after adjustment for clinical and biological characteristics and treatment regimen. Patients with baseline Hb levels </=13 g dl(-1) showed a lower treatment-induced reduction in Ki67 expression (P<0.04) and a higher Ki67 expression at postoperative evaluation (P<0.02) than their counterparts. In conclusion, low Hb levels may negatively influence the response rate of chemotherapy in breast cancer patients. Inhibition of antiproliferative activity could be a possible mechanism.

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Figures

Figure 1
Figure 1
Distribution of disease response by baseline Hb status and treatment.
Figure 2
Figure 2
Relationship between intratumoral MVD and Hb values before chemotherapy.
See this image and copyright information in PMC

References

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