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. 2014 Sep 10;9(9):e107297.
doi: 10.1371/journal.pone.0107297. eCollection 2014.

Pre-treatment anemia is a poor prognostic factor in soft tissue sarcoma patients

Joanna Szkandera  1 , Armin Gerger  1 , Bernadette Liegl-Atzwanger  2 , Michael Stotz  1 , Hellmut Samonigg  3 , Ferdinand Ploner  3 , Tatjana Stojakovic  4 , Andreas Leithner  5 , Martin Pichler  3
Affiliations

Pre-treatment anemia is a poor prognostic factor in soft tissue sarcoma patients

Joanna Szkandera et al. PLoS One. .

Abstract

Background: Anemia refers to low hemoglobin (Hb) levels, represents a common symptom and complication in cancer patients and was reported to negatively influence survival in patients with various malignancies. In the present study, we aimed to explore the prognostic impact of pre-operative Hb levels on clinical outcome in a large cohort of soft tissue sarcoma (STS) patients after curative surgery.

Methods: Retrospective data from 367 STS patients, which were operated between 1998 and 2013, were included in the study. Cut-off levels for anemia were defined as Hb<13 g/dl in males and Hb<12 g/dl in females according to the current WHO guidelines. The impact of pre-operative Hb levels on cancer-specific survival (CSS) and overall survival (OS) was assessed using Kaplan-Meier curves. Additionally, Hb levels were compared for the prognostic influence on CSS and OS applying univariate and multivariate Cox proportional models.

Results: Hb level was associated with established prognostic factors, including age, tumor grade, size and depth (p<0.05). Kaplan-Meier curves showed that low Hb levels were significantly associated with decreased CSS and OS in STS patients (p<0.001 for both endpoints, log-rank test). In multivariate analysis, we found an independent association between low Hb levels and poor CSS and OS (HR = 0.46, Cl 95% = 0.25-0.85, p = 0.012; HR = 0.34, Cl 95% = 0.23-0.51, p<0.001).

Conclusion: The present data underline a negative prognostic impact of low pre-operative Hb levels on clinical outcome in STS patients. Thus, Hb levels may provide an additional and cost-effective tool to discriminate between STS patients that are at high risk of mortality.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Kaplan-Meier curve for cancer-specific survival regarding high (≥13 g/dl in males and ≥12 g/dl in females) versus low (<13 g/dl in males and <12 g/dl in females) hemoglobin levels (p<0.001).
Figure 2
Figure 2. Kaplan-Meier curve for overall survival regarding high (≥13 g/dl in males and ≥12 g/dl in females) versus low (<13 g/dl in males and <12 g/dl in females) hemoglobin levels (p<0.001).
See this image and copyright information in PMC

References

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