Incidence of anemia in patients receiving neoadjuvant chemotherapy for locally advanced esophagogastric cancer

Ann Thorac Surg. 2004 Sep;78(3):1037-41. doi: 10.1016/j.athoracsur.2004.01.049.

Abstract

Background: There is rising evidence that anemia and blood transfusion increase perioperative mortality in cancer patients. Patients who are treated with neoadjuvant chemotherapy with a curative intent are exposed to toxicity that may negatively affect their future outcome.

Methods: The charts of 29 patients (21 males; median age, 59.5 years; range, 37 to 73), receiving neoadjuvant chemotherapy for cT3 esophagogastric adenocarcinoma operated at a single university center in the year 2002, were retrospectively reviewed to assess the incidence of anemia and blood transfusions.

Results: Twenty-six patients received platinum-based chemotherapy over a period of 12 weeks and three patients more than 6 weeks. The median hemoglobin level (Hb level) before chemotherapy was 14.0 g/dL (range, 10.4 to 15.9 g/dL), the median decline of the Hb level was 2.9 g/dL (range, 0.3 to 6.3 g/dL); this drop was statistically significant (p < 0.001, 95% confidence interval). Patients who received preoperative blood transfusions (n = 8, 28%) had a significantly increased risk of developing postoperative complications (p = 0.028).

Conclusions: Preoperative chemotherapy for locally advanced esophagogastric cancer induces anemia and therefore leads to preoperative blood supplementation in a considerable number of patients. Data indicate that this may counteract the beneficial effects of neoadjuvant treatment.

MeSH terms

  • Adenocarcinoma / drug therapy*
  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery
  • Adult
  • Aged
  • Anemia / chemically induced*
  • Anemia / epidemiology*
  • Anemia / therapy
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Cisplatin / administration & dosage
  • Cisplatin / adverse effects*
  • Disease-Free Survival
  • Erythrocyte Transfusion
  • Esophageal Neoplasms / drug therapy*
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / surgery
  • Esophagogastric Junction*
  • Female
  • Fluorouracil / administration & dosage
  • Humans
  • Incidence
  • Leucovorin / administration & dosage
  • Male
  • Middle Aged
  • Neoadjuvant Therapy / adverse effects*
  • Neoplasm Staging
  • Retrospective Studies

Substances

  • Cisplatin
  • Leucovorin
  • Fluorouracil