Anemia has been reported between 2% to 78% incidence rates in patients with solid tumors .The hemoglobin level has been reported related to treatment outcomes and survival in patients with various cancers. However,a longer term perspective including after treatment for the effects of Hb in survival analysis is still unknown. Therefore, the aims of this study were (1) to identify subgroups of cases with similar trajectories in Hb levels through different breast cancer stages; (2) to determine the independent association of Hb level trajectories in a definite treatment time interval with long term survival; and (3) to assess the survival in different cancer stage with Hb trajectories.
Data source The VGHTC Cancer Registry, a population-based cancer registry established in 1983, was approved by Taiwan Cancer Registry Database. Stastics Group-based trajectory with latent class model was used to identify distinct trajectories of hemoglobin (Hb).These models were fit using SAS ProcTraj procedure. Model fit was assessed using the Bayesian Information Criterion (BIC) and censored normal model was appropriate for continuous outcomes. Differences in clinical variables between Hb trajectories were tested with one-way analysis of variance (ANOVA) for continuous variables, and with the chi-square test for categorical variables. Survival curve was plotted by Kaplan-Meier method according by different Hb trajectory groups.
Overall, 2622 patients were enrolled and 327 patients died during follow up. We identified 5 distinct Hb trajectories: Persisted anemia (4.3%), Improved anemia (3.5%), Mild anemia (16.8%), Low normal Hb (54.9%), and normal Hb (20.5%; ).Compared with the Persisted-anemia group, trajectories with elevated Hb levels had better performance of 10 year survival.
Hb level trajectories in breast cancer treatment vary, and improved Hb level trajectory was associated with better 10-year survival. The first 12 months treatment trajectories in Hb level provide more accurate prediction in 10- year survival in breast cancer patients.
Clinical trial identification
Legal entity responsible for the study
Taichung Veterans General Hospital, Taiwan
his study was conducted and supported by the Taichung Veterans General Hospital, Taiwan (TCVGH-1055701E)
All authors have declared no conflicts of interest.