The Risk Factors Of Cancer Related Anemia In Patients With Lung Adenocarcinoma And Survival Analysis

ObjectiveThrough retrospective analysis of the clinical data of patients with newly diagnosed lung adenocarcinoma admitted to our hospital from March 2009 to December 2018,understanding the epidemiological profile of lung adenocarcinoma patients,and analyzing the incidence of anemia in lung adenocarcinoma patients before treatment,risk factors and their correlation with prognosis,and exploring variables that may be related to the overall survival(OS)of these patients.This study aimed to analyze the risk factors of cancer related anemia in patients with lung adenocarcinoma and conduct survival analysis,in order to provide a basis for standardized treatment of anemia,and early intervention to enhance the quality of life of patients with lung adenocarcinoma,and eventually,improve the survival rate.MethodsExtracting the first hospitalization data of 274 patients diagnosed with lung adenocarcinoma in our hospital from March 2009 to December 2018,including gender,date of diagnosis,age,TNM stage,treatment plan,ECOG-PS,and experimenting at admission Laboratory examination indicators(red blood cells,hemoglobin,serum albumin,hematocrit,average red blood cell hemoglobin concentration,average red blood cell hemoglobin content,average red blood cell volume).The follow-up method tracked the prognosis of patients with lung adenocarcinoma by phone and review electronic medical records.The follow-up is completed in December 2020,with the longest follow-up time being 114 months,and the shortest being 1 month.The data is acquired to establish a database statistical analysis.First,it started with analyzing the distribution of anemia before treatment in patients with lung adenocarcinoma at different ages,genders,TNM stages,PS,albumin levels,and the severity of anemia.Univariate survival analysis was used to analyze the correlation between TNM stage,gender,age,PS,treatment method,serum albumin level and hemoglobin and overall survival of patients with lung adenocarcinoma.Multivariate analysis found independent risk factors affecting prognosis,and outlined the overall survival curve of patients with lung adenocarcinoma,the survival curve of the anemia group and the non-anemia group,and the survival curve of different anemia severity levels.The measurement data is represented by the mean ± standard deviation(x±s),and the categorized variables are presented as the number of cases and the percentage(%).The comparison of count data between normal hemoglobin and low hemoglobin groups was performed by chi-square test.The grade data was compared among multiple groups and analyzed by Kruskal-Wallis H test.A binary logistic regression model was used to analyze the influencing factors of anemia with multiple factors.The K-M method was used for univariate survival analysis,and the median overall survival and survival rate were obtained,and the difference was analyzed by log-rank test.Multivariate analysis of Cox regression model was used to infer independent risk factors that affect the survival rate of patients with lung adenocarcinoma.The survival curve was drawn with Graph pad Prism 7.0 software.P<0.05 is statistically significant.Results:Among 274 patients with lung adenocarcinoma,the prevalence of anemia was 20.4%,the average Hb level was(129.13± 18.41)g/L,the prevalence of mild anemia was 17.9%,and the prevalence of moderate anemia was only 2.6%.No patient had other anemia grades(including severe anemia and severe anemia).The overall median survival time of patients with lung adenocarcinoma was 31.0 months.The 1-year survival rate was 75.2%,the 3-year survival rate was 46.7%,and the 5-year survival rate was 33.8%.In terms of risk factors,TNM staging,serum albumin(ALB)level and age are all significantly associated with the occurrence of anemia.Compared with stages Ⅰ to Ⅲ,the incidence of anemia in patients with stage IV lung adenocarcinoma was higher(26.1%vs 14.7%,P=0.019).The lower the serum albumin level,the higher the incidence of anemia in patients with lung adenocarcinoma(P<0.001).The incidence of anemia is higher for those>75 years old than those with lung adenocarcinoma between 65 and 74 years old and less than 65 years old(44.0%vs 20.2%vs 16.8%,P=0.007).And with the continuous increase of age,the severity of anemia in patients is getting higher and higher(Z=9.528,P=0.009).Survival analysis showed that in patients with lung adenocarcinoma,the OS of patients with anemia was lower than that of non-anemic patients(median OS:12 months vs 37 months,x2=14.504,P<0.001),and the anemia in patients with lung adenocarcinoma was associated with poor survival rate.The prognosis is closely related,moreover,in patients with lung adenocarcinoma,the severity of anemia grades were significantly related to the patient’s OS(x2=20.303,P<0.001).The presence or absence of anemia,TNM staging,ALB level,PS,gender,and different treatment methods have a significant impact on the survival rate of patients with lung adenocarcinoma(P<0.001).But age has nothing to do with the prognosis of lung adenocarcinoma.Further analysis showed that PS,TNM stage,serum albumin level,different treatment methods or no anti-tumor treatment can independently affect the survival rate of patients with lung adenocarcinoma(P<0.05).The mortality of patients with lung adenocarcinoma stage III and IV increased by 6.515 and 16.177 times respectively(HR=7.515,17.177).In this paper,TNM stage I is used as the reference category;the mortality rate of patients with PS>2 points is higher than that of patients with PS<2 points Increased by 2.441 times(HR=3.441);the mortality of chemotherapy patients and patients without anti-tumor treatment was 4.467 and 2.149 times higher than those in the surgical treatment group(HR=4.467,2.149).Conclusions:1.The high incidence of anemia in lung adenocarcinoma patients occurs in the group of the patients with TNM stage IV,age>75 years,and low serum albumin level.Gender and PS have no relation to the occurrence of anemia.2.Not only age is an independent risk factor for anemia in lung adenocarcinoma patients,lower serum albumin levels are also closely related to anemia in lung adenocarcinoma patients.3.This study can conclude that the independent factors affecting the death of patients with lung adenocarcinoma are TNM stage Ⅳ,PS>2,ALB<35g/L,and no anti-tumor treatment.Anemia is closely related to the survival time of patients with lung adenocarcinoma.The appearance of anemia is a prognostic indicator of shortening the survival time of patients with lung adenocarcinoma.But the based-line anemia is not an independent factor influencing the death of the patient.