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Ann Thorac Surg 2002;73:2034-2035
© 2002 The Society of Thoracic Surgeons

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Correspondence

Blood hemoglobin as an independent prognostic factor in surgically resected stages I and II non-small cell lung cancer patients

^a Laboratoire de Biologie Polyvalente, Hôpital Général, F-12027 Rodez Cedex 9, France

e-mail: j.watine{at}ch-rodez.fr

To the Editor

In the October 2000 issue, Jazieh and colleagues [1] identified the prognostic value of pretreatment blood hemoglobin in 444 resected stage I and II non-small cell lung cancer (NSCLC) patients. They demonstrated the importance of hemoglobin level in terms of overall and disease-free survival, and independently from other, more classical, prognostic covariables such as stage of the disease, histology, patients’ age, race, and gender.

In their comment, Jazieh and coworkers pointed out that "Although anemia was reported to impact outcome in lung cancer patients receiving chemotherapy or radiation therapy, its impact on the outcome of patients with early lung cancer has not been reported." It seems to us that there are several misleading statements in this particular sentence.

It is true that many more studies evaluated the pronostic significance of anemia in advanced NSCLC than in early NSCLC. However, as far we know, the only two other studies that evaluated the independent prognostic significance of this variable, in terms of survival, in early NSCLC, concluded that anemia was not significant [2, 3]. Due to potential biases in these two studies (some are explained in references [4–6]), which are also present in Jazieh and associates’ study, we cannot determine which of the three studies are most trustworthy. In the same way, the majority of numerous studies that evaluated the independent prognostic significance of anemia in advanced NSCLC patients treated with chemotherapy (some are cited in references [5, 6]) concluded that anemia was not an independent prognostic risk factor.

The only patients that all studies unanimously identify anemia to be an independent prognostic risk factor are patients treated with radiation therapy, particularly, but not only, those with advanced disease [7–9]. Although only a few studies have been published that specifically evaluated the prognostic value of anemia in radiation-treated patients (ie, three studies by two independent teams), some authors advise routine measurements of blood hemoglobin and transfusion of anemic patients before radiation therapy [8, 9].

In agreement with the revised CONSORT statement [4], it seems to us that other studies would be useful to determine if transfusion of anemic patients is useful in surgically resected NSCLC patients. Meanwhile, blood hemoglobin levels (as well as any other laboratory variable) should only be used for prognostic purposes on a routine basis by authors who have demonstrated its independent prognostic significance in their own institutions [5, 6, 10].

References

1. Jazieh A.R., Hussain M., Howington J.A., et al. Prognostic factors in patients with surgically resected stages I and II non-small cell lung cancer. Ann Thorac Surg 2000;70:1168-1171.[Abstract/Free Full Text]
2. Gail M.H., Eagan R.T., Feld R., et al. cancer study group. Prognostic factors in patients with resected stage I non-small cell lung cancer. A report from the Lung Cancer Study Group. Cancer 1984;54:1802-1813.[Medline]
3. Sorensen J.B., Badsberg J.H. Prognostic factors in resected stage I and II adenocarcinomas of the lung. A multivariate regression analysis of 137 consecutive patients. J Thorac Cardiovasc Surg 1990;99:218-226.[Abstract]
4. Moher D., Schulz K.F., Altman D.G., CONSORT Group (Consolidated Standards of Reporting Trials). The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Ann Intern Med 2001;134:657-662.[Abstract/Free Full Text]
5. Watine J. Prognostic evaluation of primary non-small cell lung carcinoma patients using biological fluid variables. A systematic review. Scand J Clin Lab Invest 2000;60:259-274.[Medline]
6. Watine J., Charet J.C. Do blood cell counts and/or differencial have an independent pretherapeutic prognostic value in primary lung cancer?. Hematol Cell Ther 1998;40:99-106.[Medline]
7. Ohlhauser C., Bülzebruck H., Ebert W., Drings P., Wannenmacher M. Prognostic factors for survival in inoperable non-small cell lung cancer: a multivariate regression analysis of 456 patients with radiation therapy. Onkologie 1997;20:126-131.
8. Wigren T., Oksanen H., Kellokumpu-Lehtinen P. A practical prognostic index for inoperable non-small cell lung cancer. J Cancer Res Clin Oncol 1997;123:259-266.[Medline]
9. Wigren T. Confirmation of a prognostic index for patients with inoperable non-small cell lung cancer. Radiother Oncol 1997;44:9-15.[Medline]
10. Watine J. Neutrophil count as prognostic factor for patients with small cell lung carcinoma. What about a more precise laboratory technique?. Cancer 2002.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Watine, J. Articles by Berteau, P. Search for Related Content PubMed Articles by Watine, J. Articles by Berteau, P.