Pretreatment anemia as a prognostic factor on overall survival in

nasopharyngeal cancer patients undergoing neoadjuvant therapy

Dominicus Wendhy Pramana1, Susanna Hilda Hutajulu2, Bambang Hariwiyanto3, Wigati
Dhamiyati D4, Ibnu Purwanto2, Kartika Widayati Taroeno-Hariadi2, Johan Kurnianda2
1

Study Program of Specialty in Internal Medicine, Department of Internal Medicine,

Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
2
Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty
of Medicine, Universitas Gadjah Mada/Dr Sardjito General Hospital, Yogyakarta,
Indonesia
3
Department of Ear, Nose, and Throat, Faculty of Medicine, Universitas Gadjah Mada/Dr
Sardjito General Hospital, Yogyakarta, Indonesia
4
Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Universitas
Gadjah Mada/Dr Sardjito General Hospital, Yogyakarta, Indonesia

Introduction. Anemia is a common finding in cancer patients. Several studies

suggest a negative impact of anemia for patients survival in different types of
cancer, including nasopharyngeal cancer (NPC).
Aim. This study aimed to analyze the prognostic role of pretreatment anemia on
NPC patients undergoing neoadjuvant therapy.
Methods. The data of 40 patients diagnosed as NPC between January 2007 and
December 2011 and undergone underwent neoadjuvant therapy with cisplatin
and 5-FU were retrospectively reviewed. Baseline hemoglobin concentration
were evaluated at diagnosis. Hemoglobin concentration of less 13 g/dL for males,
and less than 12 g/dL for females were defined as anemia. Along with other
known prognostic factors (age, and sex), the prognostic value of pretreatment
anemia were analyzed. Overall survival (OS) was assessed using the KaplanMeier method. Univariate and multivariate Cox regression models were used to
evaluate independent prognostic significance.
Results. Pretreatment anemia was observed in 12 patients (30%). Median
overall survival was 32.2 months (ranged from 28.2-37.5 months ). Patients with
pretreatment anemia showed significantly lower median overall survival than
those with normal hemoglobin concentration (21.3 vs 34.5 months, p = 0.044). In
univariate analysis, pretreatment anemia had poorer prognosis on OS, although
significance was not reached (HR = 2.68; 95% confidence interval/CI 0,98-
7,28). In multivariate analysis, none of the prognostic factors (pretreatment
anemia, sex, and age) was awere significant factors for overall survivalOS of
NPC patients undergoing neoadjuvant therapy (HR 3.92; 95% CI 0.66- 16.27,
HR 0.46; 95% CI 0.06- 3.29, and HR 2.17 95% CI 0.36- 13.21, respectively).
Conclusion. The present study indicates that pretreatment anemia had predicted
a poorer overall survivalOS in NPC patients who have undergone neoadjuvant
therapy, eventhough significance was not achieved as an independent prognostic
factor.