我们试图定义北美头颈癌患者贫血的最佳阈值,并评估其作为预后生物标志物的作用。
从2005年1月至2021年4月接受放化疗的头颈部癌症患者的单一机构数据库被查询。基于最大对数秩检验统计量定义血红蛋白(Hgb)水平的最佳阈值。Cox多变量分析(MVA),Kaplan-Meier,和倾向评分匹配用于评估治疗结果.
总共确定了496名患者。对于总生存期(OS)和无进展生存期(PFS),Hgb的阈值均为11.4。低Hgb与较差的OS(校正风险比[aHR]2.41,95%置信区间[CI]1.53-3.80,p<0.001)和PFS(aHR2.01,95%CI1.30-3.11,p=0.002)相关。在39对匹配的OS(5年OS为22.3%vs49.0%;HR2.22,95%CI1.23-4.03,p=0.008)和PFS(5年PFS24.3%vs39.1%;HR1.78,95%CI1.02-3.12,p=0.04)中观察到类似的发现。在HPV阴性肿瘤患者中,低Hgb与不良OS(aHR13.90,95%CI4.66-41.44,p<0.001)和PFS(aHR5.24,95%CI2.09-13.18,p<0.001)相关。然而,在HPV阳性肿瘤患者中,低Hgb与OS(aHR1.75,95%CI0.60-5.09,p=0.31)和PFS(aHR1.13,95%CI0.41-3.14,p=0.82)均无关。
低Hgb低于11.4是生存率较差的独立不良预后因素。它也是HPV阴性肿瘤患者的预后,但不是HPV阳性肿瘤。
We sought to define the optimal threshold for anemia in North American head and neck cancer patients and evaluate its role as a prognostic biomarker.
A single-institution database was queried for patients with head and neck cancer who underwent chemoradiation from January 2005 to April 2021. An optimal threshold of hemoglobin (Hgb) level was defined based on maximum log-rank test statistic. Cox multivariable analysis (MVA), Kaplan-Meier, and propensity score matching were performed to evaluate treatment outcomes.
A total of 496 patients were identified. Threshold for Hgb was determined to be 11.4 for both overall survival (OS) and progression-free survival (PFS). Low Hgb was associated with worse OS (adjusted hazards ratio [aHR] 2.41, 95 % confidence interval [CI] 1.53-3.80, p < 0.001) and PFS (aHR 2.01, 95 % CI 1.30-3.11, p = 0.002). Similar findings were observed among 39 matched pairs for OS (5-year OS 22.3 % vs 49.0 %; HR 2.22, 95 % CI 1.23-4.03, p = 0.008) and PFS (5-year PFS 24.3 % vs 39.1 %; HR 1.78, 95 % CI 1.02-3.12, p = 0.04). Among those with HPV-negative tumors, low Hgb was associated with worse OS (aHR 13.90, 95 % CI 4.66-41.44, p < 0.001) and PFS (aHR 5.24, 95 % CI 2.09-13.18, p < 0.001). However, among those with HPV-positive tumors, low Hgb was not associated with both OS (aHR 1.75, 95 % CI 0.60-5.09, p = 0.31) and PFS (aHR 1.13, 95 % CI 0.41-3.14, p = 0.82).
Low Hgb below 11.4 was an independent adverse prognostic factor for worse survival. It was also prognostic among patients with HPV-negative tumors, but not for HPV-positive tumors.