Purpose. Local hypoxia has been linked to a higher risk of metastasis in patients with cancer of the uterine cervix and a haemoglobin concentration of 7.45 mmol/l or less. It is unknown whether the same holds true for rectal cancer. We evaluated the independent impact of pre-operative anaemia on survival in patients with rectal cancer. Patients and methods. A random set of 144 patients diagnosed with Dukes' A, B or C rectal cancer in the period 1995-1999 and registered in the database of the Eindhoven Cancer Registry was included in a survival analysis. Parameters tested were gender, age, pre-operative haemoglobin concentration, tumour stage and therapy. The ones that showed a relation with survival (log-rank test, p<0.1) were entered in a multivariate analysis. Results. For patients without pre-operative anaemia, the hazard ratio of death was 0.35 (95% confidence interval 0.19-0.65, p=0.001), which indicates a three times higher mortality risk. For patients with a higher tumour stage (Dukes' B vs. Dukes' A or Dukes' C vs. Dukes' B) the hazard ratio of death was 1.52 (95% CI 1.04-2.23, p=0.03). For older patients (64-73 years vs. <64 years or >73 years vs. 64-73 years) the hazard ratio of death was 1.85 (95% CI 1.29-2.63, p=0.001). Conclusion. Long-term survival was significantly affected in rectal cancer patients with pre-operative anaemia. Further study on the relation between anaemia, tumour oxygenation and prognosis is needed, as it may have implications for future therapy.

Additional Metadata
Keywords Anaemia, Hypoxia, Prognosis, Rectal cancer
Persistent URL dx.doi.org/10.1016/j.ejso.2004.04.014, hdl.handle.net/1765/64702
Journal European Journal of Surgical Oncology
Citation
van Halteren, H.K, Houterman, S, Verheij, C.D.G.W, Lemmens, V.E.P.P, & Coebergh, J.W.W. (2004). Anaemia prior to operation is related with poorer long-term survival in patients with operable rectal cancer. European Journal of Surgical Oncology, 30(6), 628–632. doi:10.1016/j.ejso.2004.04.014