Presence of Anemia and Poor Prognostic Factors in Patients with Endometrial Carcinoma

Abstract

This study evaluated the relationship between pretreatment hemoglobin (Hb) and prognostic factors in Thaipatients with endometrial cancer. Medical records of 228 patients who had undergone surgery between January2005 and December 2007 were retrospectively reviewed. Associations between clinicopathological variables andpretreatment Hb levels were described using Pearson’s chi square test or two-tailed Fisher’s exact test. Survivalanalysis was performed with Kaplan-Meier estimates. Univariate and Cox-regression models were used toevaluate the prognostic impact of various factors, including Hb levels, in term of disease-free survival. The medianduration of follow-up was 38.2 months. Eighty-nine patients (39%) had a preoperative Hb level of <12 g/dL, thesehaving significantly higher rates of non-endometrioid histology, advanced FIGO stage, lymphovascular spaceinvasion, cervical involvement, adnexal involvement, positive peritoneal cytology, and lymph node involvementthan patients with Hb ≥12 g/dL. The 5-year disease-free and overall survival were significantly lower in patientswith pretreatment Hb levels <12 g/dL compared with those with Hb ≥12 g/dL (79.3% vs. 89.2%, p=0.044 and87.6% vs. 99.3%, p<0.001, respectively). In the multivariate analysis only histology, myometrial invasion, andlymphovascular invasion proved to be independent prognostic factors, whereas tumor grading, stage, cervicalinvolvement, adnexal involvement, positive peritoneal cytology, lymph node involvement, and low Hb werenot. In conclusion, presence of anemia before treatment may reflect poor prognostic factors in patients withendometrial cancer and low pretreatment hemoglobin level may have a prognostic impact on clinical outcome.