The Risk Factors And Survival Analysis Of Non-small Cell Lung Cancer With Anemia

Objective: In recent years,the incidence of cancer is rising.Because of the treatment increasing,the survival time is prolonged than before.However,the cancer related complications get more and more.Cancer related anemia is common concomitant disease,the reasons of anemia are as follows: bleeding that is caused by the tumor invading the blood vessels,reduced bone marrow function which is led by the tumor invading bone narrow,bone marrow suppression that is caused by the radiotherapy or chemotherapy,nutrient absorption which is led by gastrointestinal damaging,and so on.Cancer related anemia decreases the quality of life,reduces the efficacy of radiotherapy and chemotherapy,and even promotes tumor metastasis,affects the survival time of patients.However,patients and clinicians pay the less attention to the cancer related anemia.Anemia has not been adequately treated.Gastrointestinal cancer,breast cancer and lung cancer are the top three in all types of cancer incidence of anemia.Lung cancer is the top cancer morbidity and mortality in our country and the world.In lung cancer,non-small cell lung cancer(NSCLC)is more than 80%.The study investigates the risk factors in patients with anemia,the survival differences in NSCLC patients with anemia or not,the survival differences in patients with anti-anemia treatment or not.The study will make cancer related anemia received more attentions.We will seek evidences for standardized treatment of NSCLC patients with anemia.Method: The study’s patients are the first time visiting to the Fourth Hospital of Hebei Medical University and diagnosed with non-small cell lung cancer by histopathological or cytological during January 2008 to December 2014,in total of 848 cases.The cases include the patient’s general clinical pathology,related blood routine test,liver function test,specific treatment,and follow-up by telephone,these are established into appropriate information database.Statistical analysis is performed with the SPSS 13.0 statistical software.The count data are described by frequency,the relationship between the clinical pathological features and the incidence of anemia are analyzed by X2 test,using Logistic regression explores the risk factors associated with anemia.Using Kaplan-Meier method draws survival curves,using the Log-Rank test analyzes the survival rates of different groups,P <0.05 as statistically significant test standard.Result: 1.The relationship between the general clinical pathological data and anemia: This study includes 848 cases of NSCLC patients.Tumor staging(Χ~2=16.742,P=0.001),serum albumin level(Χ~2=32.643,P<0.001)influence the incidence of anemia.The patient’s age,gender,pathological nature,history of smoking and EGFR gene status affect the incidence of anemia differently,while the differences are not statistically significant.2.The relationship between the treatment and anemia: Different treatments have different effects on the incidence of anemia(Χ~2=37.490,P<0.001).Surgery(Χ~2=9.605,P=0.002),chemotherapy(Χ~2=17.428,P<0.001),symptomatic and supportive treatment(Χ~2=3.908,P=0.048)influence the incidence of anemia.The anti-angiogenesis drugs(Χ~2=3.188,P=0.074),radiation therapy(Χ~2=0.296,P=0.586),biological therapy(Χ~2=0.071,P=0.789),concurrent chemoradiotherapy(Χ~2=1.678,P=0.193),targeted therapy(Χ~2=0.745,P=0.388)have no effects on the influence of anemia.3.Risk factors for anemia: The use of statistical methods Logistic regression multivariate analysis finds that chemotherapy,albumin levels are the risk factors for anemia,surgery is the protect factor,chi-square test shows that the coefficients of each variable are statistically significant(Χ~2 = 33.208,P <0.001).4.Survival Analysis: In this study,the shortest overall survival is 1 month,the longest is 86 months,median survival time is 17 months with the 848 cases of NSCLC patients.The median survival time of anemia group and non-anemia group are 15 months and 19 months,Log-Rank test shows that the differences are significant(P = 0.001).The median survival time of using anti-anemia treatment and not undergoing anti-anemia treatment patients is 20 months,13 months,there is a significant difference between the two groups in overall survival(P <0.001).Different stages have different OS,the earlier stage‘s OS is longer,prognosis is better.Conclusion:1 Single factor statistical analysis: the NSCLC patients with later TNM stage,hypoproteinemia and chemotherapy have the higher incidence of anemia.The surgery,symptomatic and supportive treatment can make the incidence of anemia lower.Different age groups,gender,pathological nature,history of smoking,EGFR gene status,the application of anti-angiogenic drugs,radiation therapy,biological therapy,targeted therapy are not associated with anemia’s incidence.2 After a multivariate statistical analysis: we find that chemotherapy and hypoproteinemia are the risk factors of NSCLC anemia patients,while the surgery is the protect factor.3 There is a difference between the patients with anemia and not with anemia in non-small cell lung cancer.The anemia has a shorter survival time.Anemia is a prognostic indicator of non-small cell lung cancer patients.4 The patients with anemia in non-small cell lung cancer have a relatively longer time to live after anti-anemia treatment.Anemia treatment is a prognostic indicator in the non-small cell lung cancer patients with anemia.