Prognostic Value Of Changes In Hemoglobin Concentration During Treatment For Local Control Of Nasopharyngeal Carcinoma

OBJECTIVES To examine whether changes in hemoglobin concentration during treatment local control therapy of nasopharyngeal caicinoma (NPC) can predict outcomes.METHODS Clinical and follow-up date of443NPC patients received definitive treatment,including radiotherapy and chemotherapy from2003-2008at Guangxi Autonomous Regional Cancer Hospital were reviewed. The mean of the hemoglobin concentration during treatment compared with pre-treatment hemoglobin concentration in all of the patients,which were classified into two groups:one group experienced an increase in hemoglobin concentration during radiotherapy(n=51) or a combination of radiotherapy and chemotherapy (n=90);the other group experienced a decrease in hemoglobin after radiotherapy (n=110) or a combination of radiotherapy and chemotherapy (n=192). The radiotherapy included conventional ractionated radiotherapy and intensity modulated radiation therapy. Chemotherapy was composed of induction chemotherapy, concurrent chemoradiotherapy and adjuvant chemotherapy.Relationships between hemoglobin concentration changes and survival outcomes were analyzed.RESULTS The median hemoglobin concentration during treatment of the443patienrs was119g/L.Hemoglobin was increased in141(31.8%) patients,and decreased in302(68.2%) patients. The group experiencing an increase in hemoglobin presented significantly greater rates5-year local relapse-free survival (53.5%VS37.5%,p=0.013),5-year distant metastasis-free survival (58.5%VS37.4%, P=0.009) and5-year overall survival (43.3%VS27.7%, P=0.003).Univariate analysis showed that age (P=0.007), patients with anemia after (P=0.006) and during (P=0.001) treatment, T staging (P=0.002) and changes in hemoglobin concentration during treatment (P=0.013) were prognositic factors of NPC loco-rigional recurrence-free survival,and it also showed that age (P=0.000), patients with anemia before (P=0.020), during (p=0.009) and after treatment (P=0.008), T staging (P=0.005) and changes in hemoglobin concentration during treatment (P=0.009) were prognositic factors of NPC with distant metastasis.In addition, age (P=0.000), patients with anemia before (P=0.025),during (P=0.002) and after (P=0.019) treatment, T staging (P=0.000) and changes in hemoglobin concentration during treatment (P=0.003) were prognositic factors of NPC with overall Survial. Multivariate analysis identified age>60years (P=0.000), patients with anemia before (p=0.027) and during treatment (P=0.019),T staging (P=0.019) and an increase in hemoglobin concentration during treatment (P=0.011) as independent prognostic factors for failure of local control therapy.CONCLUSION The NPC patients who had an increase in hemoglobin during treatment had a better local control and overall Survial than those who had an decrease; An increase in hemoglobin concentration during treatment is a prognostic factor for local control of NPC. Changes in hemoglobin concentration during treatment is expected to guide the clinical treatment.