Effect of Baseline Hemoglobin Level on Prognosis in Nasopharyngeal Cancer Patients Receiving Chemoradiotherapy

Objective: To explore retrospectively how pretreatment hemoglobin levels affected the prognosis of patients with nasopharyngeal cancer receiving chemoradiotherapy.

Methods: Clinical data of 97 nasopharyngeal cancer patients who received definitive chemoradiotherapy between 2000 and 2022 were analyzed. We accepted the cut-off value of hemoglobin as 11.0g/dL.

Results: In general, 13 (13%) of patients were Hb≤11g/dL, while 84 (86%) was Hb>11g/dL.  Median survival times were 76 (95%CI 19-132) months and 205 (95%CI 157-252) months for Hb≤11g/dL and Hb>11g/dL patients, respectively. 1, 2, 3 and 5 year survival rates were 67.7%, 67.7%, 67.7% and 58% for Hb≤11g/dL and 90.3%, 83.6.2%, 75.2% and 66.1% for Hb>11g/dL patients, respectively, and this difference show no statistical significance (p=0.254). When we evaluated patients according to WHO criteria for anemia (hemoglobin <12g/dL (female) or <13g/dL (male)), the median survival time was 220 (95%CI 190-255) months for non-anemic patients whereas it was 76 (95%CI 0-157) months for anemic patients. 1, 2, 3 and 5 year survival rates were 92.5%, 87.6%, 78.8% and 68.9% for non-anemic and 75%, 67.5%, 63.7% and 55.8% for anemic patients, respectively. There was statistically significant difference between the two groups (p=0.013).

Conclusion: In our study, although Hb<11g/dl before chemoradiotherapy did not show a statistically significant difference in nasopharyngeal cancer patients, the median overall survival of 76 months in Hb≤11g/dL patients and 205 months for Hb>11g/dL patients. However, pretreatment anemia according to WHO criteria, and Hb≤11 g/dL in male patients were found to be independent adverse prognostic factors.