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Observational Study
. 2015 Jan;100(1):124-32.
doi: 10.3324/haematol.2014.112813. Epub 2014 Sep 19.

The role of inflammation, iron, and nutritional status in cancer-related anemia: results of a large, prospective, observational study

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Observational Study

The role of inflammation, iron, and nutritional status in cancer-related anemia: results of a large, prospective, observational study

Antonio Macciò et al. Haematologica. 2015 Jan.

Abstract

Anemia in oncology patients is often considered a side effect of cancer therapy; however, it may occur before any antineoplastic treatment (cancer-related anemia). This study was aimed to evaluate the prevalence of cancer-related anemia in a large cohort of oncology patients and whether inflammation and malnutrition were predictive of its development and severity. The present study included 888 patients with cancer at different sites between May 2011 and January 2014. Patients were assessed at diagnosis before any cancer treatment. The prevalence of anemia according to the main clinical factors (tumor site, stage and performance status) was analyzed. In each patient markers of inflammation, iron metabolism, malnutrition and oxidative stress as well as the modified Glasgow prognostic score, a combined index of malnutrition and inflammation, were assessed and their role in predicting hemoglobin level was evaluated. The percentage of anemic patients was 63% with the lowest hemoglobin levels being found in the patients with most advanced cancer and compromised performance status. Hemoglobin concentration differed by tumor site and was lowest in patients with ovarian cancer. Hemoglobin concentration was inversely correlated with inflammatory markers, hepcidin, ferritin, erythropoietin and reactive oxygen species, and positively correlated with leptin, albumin, cholesterol and antioxidant enzymes. In multivariate analysis, stage, interleukin-6 and leptin were independent predictors of hemoglobin concentration. Furthermore, hemoglobin was inversely dependent on modified Glasgow Prognostic Score. In conclusion, cancer-related anemia is a multifactorial problem with immune, nutritional and metabolic components that affect its severity. Only a detailed assessment of the pathogenesis of cancer-related anemia may enable clinicians to provide safe and effective individualized treatment VSports手机版. .

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Figures

Figure 1.
Figure 1.
Evaluation of Hb levels according to mGPS categories. (A) Bars represent mean ±SD. Mean Hb levels were significantly different between mGPS categories (ANOVA test; P<0.001). The post-hoc test showed that Hb level was lower in patients in the highest mGPS category vs. the other mGPS categories (mGPS 0 vs. mGPS 1 category, P<0.001; mGPS 0 vs. mGPS 2, P<0.001; mGPS 1 vs. mGPS 2, P=0.045). (B) Scatter plots with linear regression line (black line) showing that mGPS category is a significant negative predictor of Hb level (dependent variable) (β coefficient=−1.176; P<0.001). mGPS: modified Glasgow prognostic score; Hb: hemoglobin.

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