PURPOSE: Early stage non-small cell lung cancer patients are a heterogeneous population, and include patients who undergo sub-lobar pulmonary resection or neo-adjuvant therapy. Pre-operative anemia has been shown to be an ominous prognostic factor for long term survival in this group of patients. The purpose of this study is to investigate the impact anemia has on survival on a selected group of 214 patients who underwent only lobectomy or pneumonectomy and have not received neo-adjuvant treatment.
METHODS: Two hundred fourteen consecutive patients who underwent lobectomy, bilobectomy or pneumonectomy for surgical stage I and II non small cell lung cancer between January 2001 and May 2006 without neo-adjuvant treatment at three institutions were included in the analysis. Data were prospectively collected during admission. Patients were divided in four quartiles based on their admission hemoglobin: group I: Hgb≤;12 gm/dl, group II: Hgb=12.1-12.9gm/dl, group III: Hgb=13.0-14.0 gm/dl, and group IV: Hgb>14gm/dl. Cox regression analysis was used evaluate each variable's impact on midterm survival based on all causes and lung cancer specific mortality. Survival plots were estimated based on Kaplan-Meier analysis.
RESULTS: Mean follow up was 34.1 months (0.1-67.4 months). Thirty seven deaths (17.3%) occurred during the follow up period. Preoperative hemoglobin (HR =1.44, p=0.014) and pneumonectomy (HR=3.58, p=0.017) were the only predictors of midterm all causes mortality. If lung cancer related deaths were considered preoperative hemoglobin (HR=1.81, p=0.007) and pneumonectomy (HR=6.89, p=0.001,) were independent survival predictors. Age, gender, pre-operative pulmonary function test results, diabetes, congestive heart failure, renal failure, tumor stage, and histology did not influence survival.
CONCLUSION: Preoperative anemia and type of resection in early stage non small cell lung cancer have impact on midterm term survival and lung cancer specific mortality in this selected group of patients. Anemia may indicate a more aggressive tumor that places a patient at increased risk for future relapse and need for adjuvant therapy.
CLINICAL IMPLICATIONS: Adjuvant therapy should be considered post-operatively even in early stage non small cell lung cancer patients who have low pre-operative hemoglobin.
DISCLOSURE: Themistokles Chamogeorgakis, No Financial Disclosure Information; No Product/Research Disclosure Information