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Shenoy G, Slagle-Webb B, Khunsriraksakul C, Pandya Shesh B, Luo J, Khristov V, Smith N, Mansouri A, Zacharia BE, Holder S, Lathia JD, Barnholtz-Sloan JS, Connor JR. Analysis of anemia and iron supplementation among glioblastoma patients reveals sex-biased association between anemia and survival. Sci Rep 2024; 14:2389. [PMID: 38287054 PMCID: PMC10825121 DOI: 10.1038/s41598-024-52492-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024] Open
Abstract
The association between anemia and outcomes in glioblastoma patients is unclear. We analyzed data from 1346 histologically confirmed adult glioblastoma patients in the TriNetX Research Network. Median hemoglobin and hematocrit levels were quantified for 6 months following diagnosis and used to classify patients as anemic or non-anemic. Associations of anemia and iron supplementation of anemic patients with median overall survival (median-OS) were then studied. Among 1346 glioblastoma patients, 35.9% of male and 40.5% of female patients were classified as anemic using hemoglobin-based WHO guidelines. Among males, anemia was associated with reduced median-OS compared to matched non-anemic males using hemoglobin (HR 1.24; 95% CI 1.00-1.53) or hematocrit-based cutoffs (HR 1.28; 95% CI 1.03-1.59). Among females, anemia was not associated with median-OS using hemoglobin (HR 1.00; 95% CI 0.78-1.27) or hematocrit-based cutoffs (HR: 1.10; 95% CI 0.85-1.41). Iron supplementation of anemic females trended toward increased median-OS (HR 0.61; 95% CI 0.32-1.19) although failing to reach statistical significance whereas no significant association was found in anemic males (HR 0.85; 95% CI 0.41-1.75). Functional transferrin-binding assays confirmed sexually dimorphic binding in resected patient samples indicating underlying differences in iron biology. Anemia among glioblastoma patients exhibits a sex-specific association with survival.
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Affiliation(s)
- Ganesh Shenoy
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Becky Slagle-Webb
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | | | | | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery and Siteman Cancer Center Biostatistics Shared Resource, Washington University School of Medicine, St. Louis, MO, USA
| | - Vladimir Khristov
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Nataliya Smith
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Brad E Zacharia
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Sheldon Holder
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, USA
| | - Justin D Lathia
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jill S Barnholtz-Sloan
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, MD, USA
| | - James R Connor
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA.
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2
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Abstract
Glioblastoma (GBM) is among the deadliest malignancies facing modern oncology. While our understanding of certain aspects of GBM biology has significantly increased over the last decade, other aspects, such as the role of bioactive metals in GBM progression, remain understudied. Iron is the most abundant transition metal found within the earth's crust and plays an intricate role in human physiology owing to its ability to participate in oxidation-reduction reactions. The importance of iron homeostasis in human physiology is apparent when examining the clinical consequences of iron deficiency or iron overload. Despite this, the role of iron in GBM progression has not been well described. Here, we review and synthesize the existing literature examining iron's role in GBM progression and patient outcomes, as well as provide a survey of iron's effects on the major cell types found within the GBM microenvironment at the molecular and cellular level. Iron represents an accessible target given the availability of already approved iron supplements and chelators. Improving our understanding of iron's role in GBM biology may pave the way for iron-modulating approaches to improve patient outcomes.
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Affiliation(s)
- Ganesh Shenoy
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - James R Connor
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
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3
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Shenoy G, Kheirabadi S, Ataie Z, Sahu AP, Palsa K, Wade Q, Khunsriraksakul C, Khristov V, Slagle-Webb B, Lathia JD, Wang HG, Sheikhi A, Connor JR. Iron inhibits glioblastoma cell migration and polarization. FASEB J 2023; 37:e23307. [PMID: 37983646 DOI: 10.1096/fj.202202157rr] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023]
Abstract
Glioblastoma is one of the deadliest malignancies facing modern oncology today. The ability of glioblastoma cells to diffusely spread into neighboring healthy brain makes complete surgical resection nearly impossible and contributes to the recurrent disease faced by most patients. Although research into the impact of iron on glioblastoma has addressed proliferation, there has been little investigation into how cellular iron impacts the ability of glioblastoma cells to migrate-a key question, especially in the context of the diffuse spread observed in these tumors. Herein, we show that increasing cellular iron content results in decreased migratory capacity of human glioblastoma cells. The decrease in migratory capacity was accompanied by a decrease in cellular polarization in the direction of movement. Expression of CDC42, a Rho GTPase that is essential for both cellular migration and establishment of polarity in the direction of cell movement, was reduced upon iron treatment. We then analyzed a single-cell RNA-seq dataset of human glioblastoma samples and found that cells at the tumor periphery had a gene signature that is consistent with having lower levels of cellular iron. Altogether, our results suggest that cellular iron content is impacting glioblastoma cell migratory capacity and that cells with higher iron levels exhibit reduced motility.
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Affiliation(s)
- Ganesh Shenoy
- Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Sina Kheirabadi
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Zaman Ataie
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Aurosman Pappus Sahu
- Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kondaiah Palsa
- Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Quinn Wade
- Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Chachrit Khunsriraksakul
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Vladimir Khristov
- Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Becky Slagle-Webb
- Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Justin D Lathia
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hong-Gang Wang
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Amir Sheikhi
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - James R Connor
- Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
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4
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Kaisman-Elbaz T, Elbaz Y, Merkin V, Dym L, Noy A, Atar-Vardi M, Bari R, Turiel S, Alt A, Zamed T, Eskira Y, Lavrenkov K, Kezerle Y, Dyomin V, Melamed I. Hemoglobin Levels and Red Blood Cells Distribution Width Highlights Glioblastoma Patients Subgroup With Improved Median Overall Survival. Front Oncol 2020; 10:432. [PMID: 32426265 PMCID: PMC7212453 DOI: 10.3389/fonc.2020.00432] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/11/2020] [Indexed: 12/12/2022] Open
Abstract
Glioblastoma multiforme (GBM) is known for its dismal prognosis, though its dependence on patients' readily available RBCs parameters is not fully established. In this work, 170 GBM patients, diagnosed and treated in Soroka University Medical Center (SUMC) over the last 12 years were retrospectively inspected for their survival dependency on pre-operative RBCs parameters. Besides KPS and tumor resection supplemented by oncological treatment, age under 70 (HR = 0.4, 95% CI 0.24–0.65, p = 0.00073), low hemoglobin level (HR = 1.79, 95% CI 1.06–2.99, p = 0.031), and Red Cell Distribution Width (RDW) < 14% (HR = 0.57, 95% CI 0.37–0.88, p = 0.018) were found to be prognostic of patients' overall survival in multivariate analysis, accounting for a false discovery rate of < 5% due to multiple hypothesis testing. According to these results, a stratification tree was made, from which a favorable route highlighted a subgroup of nearly 30% of the cohorts' patients whose median overall survival was 21.1 months (95% CI 16.2–27.2)—higher than the established chemo-radiation standard first-line treatment regimen overall median survival average of about 15 months. The beneficial or detrimental effect of RBCs parameters on GBM prognosis and its possible causes is discussed.
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Affiliation(s)
- Tehila Kaisman-Elbaz
- Department of Neurosurgery, Soroka University Medical Center, Be'er Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yonatan Elbaz
- Physics Department, Nuclear Research Center - Negev, Be'er Sheva, Israel
| | - Vladimir Merkin
- Department of Neurosurgery, Soroka University Medical Center, Be'er Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Lianne Dym
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ariel Noy
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Maya Atar-Vardi
- Clinical Research Center, Soroka University Medical Center, Be'er Sheva, Israel
| | - Romi Bari
- Clinical Research Center, Soroka University Medical Center, Be'er Sheva, Israel
| | - Sivan Turiel
- Clinical Research Center, Soroka University Medical Center, Be'er Sheva, Israel
| | - Adi Alt
- Department of Neurosurgery, Soroka University Medical Center, Be'er Sheva, Israel
| | - Tali Zamed
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yael Eskira
- Department of Neurosurgery, Soroka University Medical Center, Be'er Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Konstantin Lavrenkov
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Institute of Oncology, Soroka University Medical Center, Be'er Sheva, Israel
| | - Yarden Kezerle
- Institute of Pathology, Soroka University Medical Center, Be'er Sheva, Israel
| | - Victor Dyomin
- Institute of Pathology, Soroka University Medical Center, Be'er Sheva, Israel
| | - Israel Melamed
- Department of Neurosurgery, Soroka University Medical Center, Be'er Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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5
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Routine Blood Tests Do Not Predict Survival in Patients with Glioblastoma-Multivariable Analysis of 497 Patients. World Neurosurg 2019; 126:e1081-e1091. [PMID: 30880204 DOI: 10.1016/j.wneu.2019.03.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Multiple reports have attributed a prognostic value to routine blood tests results for patients with glioblastoma. However, these studies have reported conflicting results and have often had small sample sizes. We sought to validate the prognostic value of the described tests in an independent glioblastoma patient population. METHODS We performed a retrospective single-center multivariable analysis of 497 patients with glioblastoma who had postoperatively undergone radiotherapy and/or chemotherapy to identify the prognostic value for median overall survival of hemoglobin, white blood cell, monocyte, neutrophil, leukocyte, and platelet counts, neutrophil/lymphocyte ratio, C-reactive protein, erythrocyte sedimentation rate, activated partial thromboplastin time, prothrombin time, and lactate dehydrogenase. We also evaluated known prognostic factors for survival such as patient age, intervention type, IDH1 status, Karnofsky clinical performance status, and postoperative treatment modality. RESULTS In a multivariable model, after correcting for multiple testing bias, biopsy alone (hazard ratio, 0.35; 95% confidence interval, 0.26-0.49; false discovery rate-adjusted P < 0.001) and monotherapy after surgery (hazard ratio, 0.46; 95% confidence interval, 0.33-0.66; false discovery rate-adjusted P < 0.001) remained significantly associated with worse median overall survival. Patient age and Karnofsky performance status score ≥70 did not significantly influence survival in the multivariable model. No routine blood test included in the multivariable analysis was significantly associated with survival. CONCLUSIONS In the present study, hemoglobin, white blood cell, monocyte, neutrophil, leukocyte, and platelet counts, neutrophil/lymphocyte ratio, C-reactive protein, erythrocyte sedimentation rate, activated partial thromboplastin time, prothrombin time, and lactate dehydrogenase levels did not independently predict for overall survival in patients with glioblastoma.
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6
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Le M, Garcilazo Y, Ibáñez-Juliá MJ, Younan N, Royer-Perron L, Benazra M, Mokhtari K, Houillier C, Hoang-Xuan K, Alentorn A. Pretreatment Hemoglobin as an Independent Prognostic Factor in Primary Central Nervous System Lymphomas. Oncologist 2019; 24:e898-e904. [PMID: 30867243 DOI: 10.1634/theoncologist.2018-0629] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/20/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal lymphoma. Despite established clinical prognostic scoring such as that of the Memorial Sloan Kettering Cancer Center (MSKCC) and the International Extranodal Lymphoma Study Group, outcome prediction needs to be improved. Several studies have indicated an association between changes in hematologic laboratory parameters with patient outcomes in PCNSL. We sought to assess the association between hematological parameters and overall survival (OS) in patients with PCNSL. METHODS Pretreatment blood tests were analyzed in patients with newly diagnosed PCNSL (n = 182), and we divided the analysis into two cohorts (A and B, both n = 91). OS was evaluated using the Cox proportional hazards models and log-rank test. Furthermore, the accuracy of the different multivariate models was assessed by Harrell's concordance index (C-index). RESULTS Using prechemotherapy blood tests, anemia was found in 38 patients (41.8%) in cohort A and 34 patients (37.4%) in cohort B. In univariate analysis, anemia (<12 g/dL in women and <13 g/dL in men) was significantly associated with OS. None of the other blood tests parameters (neutrophils, lymphocyte, or platelets counts) or their ratios (neutrophil-to-lymphocyte ratio and neutrophil-to-platelets ratio) were associated with OS. In multivariate analysis, after adjusting by MSKCC score, anemia remained an independent prognostic factor. Interestingly, the prediction accuracy of OS using Harrell's C-index was similar using anemia or MSKCC (mean C-index, 0.6) and was increased to 0.67 when combining anemia and MSKCC. CONCLUSION The presence of anemia was associated with poor prognosis in both cohorts of PCNSL. Validation of these results and biologic role of hemoglobin levels in PCNSL requires further investigation. IMPLICATIONS FOR PRACTICE The prediction of the outcome of primary central nervous system lymphoma (PCNSL) using the most frequently used scores (i.e., Memorial Sloan Kettering Cancer Center [MSKCC] or International Extranodal Lymphoma Study Group) needs to be improved. We analyzed a large cohort of PCNSL to dissect the potential prognostic value of blood tests in this rare entity. We found anemia as an independent predictor for overall survival in PCNSL. Interestingly, the accuracy to predict PCNSL outcome was improved using hemoglobin level. This improvement was additional to the currently used clinical score (i.e., MSKCC). Finally, none of the other blood tests parameters or their ratios had a prognostic impact in this study.
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Affiliation(s)
- My Le
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Ytel Garcilazo
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Maria-José Ibáñez-Juliá
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Nadia Younan
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Unité Mixte de Recherche (UMR) 1127, INSERM U1127, Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne University-Pitié-Salpêtrière University Hospital-Centre National de la Recherche (CNRS), Paris, France
| | - Louis Royer-Perron
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Marion Benazra
- Unité Mixte de Recherche (UMR) 1127, INSERM U1127, Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne University-Pitié-Salpêtrière University Hospital-Centre National de la Recherche (CNRS), Paris, France
| | - Karima Mokhtari
- Laboratory Escourolle, Department of Neuropathology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Onconeurotek Tumour Bank, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Unité Mixte de Recherche (UMR) 1127, INSERM U1127, Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne University-Pitié-Salpêtrière University Hospital-Centre National de la Recherche (CNRS), Paris, France
| | - Caroline Houillier
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Lymphome Oculo-Cérébral (LOC) Network, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Khê Hoang-Xuan
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Lymphome Oculo-Cérébral (LOC) Network, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Unité Mixte de Recherche (UMR) 1127, INSERM U1127, Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne University-Pitié-Salpêtrière University Hospital-Centre National de la Recherche (CNRS), Paris, France
| | - Agusti Alentorn
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Unité Mixte de Recherche (UMR) 1127, INSERM U1127, Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne University-Pitié-Salpêtrière University Hospital-Centre National de la Recherche (CNRS), Paris, France
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7
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Karimi S, Vyas MV, Gonen L, Tabasinejad R, Ostrom QT, Barnholtz-Sloan J, Suppiah S, Zadeh G, Aldape K. Prognostic significance of preoperative neutrophilia on recurrence-free survival in meningioma. Neuro Oncol 2018; 19:1503-1510. [PMID: 28531342 DOI: 10.1093/neuonc/nox089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Meningioma is the most common primary intracranial tumor and recurrence is one of the important challenges in patient management. Prognostic factors for tumor recurrences in these patients especially before surgical resection are not fully characterized. Several studies have indicated an association between changes in hematologic laboratory parameters with patient outcomes in solid malignancies. We aimed to assess the association between hematologic parameters and tumor recurrence in patients with meningioma. Methods Preoperative complete blood count (CBC) data were analyzed in patients with newly diagnosed meningioma (n = 222). Clinical data, including history of corticosteroid therapy, tumor characteristics, and follow-up, were obtained. Recurrence-free survival (RFS) was evaluated using Cox proportional hazards models and log-rank tests. Results Using preoperative CBC data from patients prior to any steroid therapy, 51 (23%) patients had neutrophilia. In univariate analysis, neutrophilia was significantly associated with meningioma recurrence (hazard ratio [HR] 2.73; P < 0.01). Neither leukocytosis nor lymphocytosis was associated with RFS. In multivariate analysis, after adjusting for tumor grade, tumor size, and extent of resection, neutrophilia remained an independent prognostic factor for RFS (HR 2.23, P = 0.01). Forty-six (21%) patients had low hemoglobin levels indicative of anemia, and the presence of anemia showed a trend toward high risk for recurrence (HR 1.83; P = 0.06). Conclusions The presence of neutrophilia was associated with higher rate of tumor recurrence in patients with meningioma. Validation of these results and the biologic role of neutrophilic inflammatory/immune reaction in meningioma requires further investigation.
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Affiliation(s)
- Shirin Karimi
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Manav V Vyas
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Lior Gonen
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Raha Tabasinejad
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Quinn T Ostrom
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Jill Barnholtz-Sloan
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Suganth Suppiah
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Gelareh Zadeh
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Kenneth Aldape
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
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8
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Liang RF, Li M, Yang Y, Mao Q, Liu YH. Significance of Pretreatment Red Blood Cell Distribution Width in Patients with Newly Diagnosed Glioblastoma. Med Sci Monit 2017; 23:3217-3223. [PMID: 28667816 PMCID: PMC5505574 DOI: 10.12659/msm.905204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Red blood cell distribution width (RDW) is a parameter of the complete blood count (CBC) test. Recent evidence suggests that pretreatment RDW is associated with patient survival in various malignant tumors. We explored the association of pretreatment RDW and other red blood cell (RBC) parameters with clinical parameters and assessed their prognostic impact on overall survival (OS) in patients with glioblastoma (GBM). MATERIAL AND METHODS In total, 109 patients with newly diagnosed GBM were retrospectively reviewed. The Cox proportional hazards regression model and Kaplan-Meier method were used to examine the survival function of pretreatment RDW, mean cell volume (MCV), hemoglobin (HGB), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), RBC count, and hematocrit (HCT) values in patients with newly diagnosed GBM. RESULTS Univariate analysis showed that MCV, MCHC, and RDW were associated with overall survival (OS). However, only RDW remained significant in multivariate analysis. The Kaplan-Meier survival curves showed that patients belonging to the high-RDW group had a worse median OS (293 days versus 375 days, P=0.023) than those belonging to the low-RDW group. CONCLUSIONS The present study showed that pretreatment RDW was superior to MCV and MCHC as a prognostic predictor of clinical outcome in patients newly diagnosed with GBM. Pretreatment RDW was derived directly from the CBC test, which can be easily performed in clinical practice. Therefore, pretreatment RDW values can provide additional prognostic information for patients with GBM. Further larger and prospective studies are needed to confirm these findings and to investigate the mechanism by which of RDW is associated with prognosis in patients with GBM.
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Affiliation(s)
- Ruo-Fei Liang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Mao Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yuan Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Qing Mao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yan-Hui Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
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9
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Liang XX, Li Q, Su Z, Lan XW, Ouyang PY, Mao YP, Shi DB, Deng WG, Cheng ZB, Wang SY, Xie FY. Significant prognostic impact of chemoradiotherapy-induced hemoglobin decrease on treatment outcomes of nasopharyngeal carcinoma. J Cancer 2015; 6:502-10. [PMID: 26000040 PMCID: PMC4439934 DOI: 10.7150/jca.11403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 02/10/2015] [Indexed: 12/12/2022] Open
Abstract
Purpose: To investigate prognostic impact of chemoradiotherapy-induced hemoglobin (Hb) decrease on treatment outcomes of endemic nasopharyngeal carcinoma (NPC). Materials and Methods: Eight hundred and fifteen non-metastatic NPC, receiving neoadjuvant chemotherapy followed by radiotherapy (NACT+RT group) or concomitant chemoradiotherapy (CCRT group), were enrolled in this study, who were regrouped according to pre-radiotherapy Hb (pre-RT Hb), post-radiotherapy Hb (post-RT Hb) and individual Hb decrease through radiotherapy or CCRT (△Hb), respectively. Survival curves were estimated using Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using the COX proportional hazard model and binary logistic regression model. Results: A poorer 5-year disease-free survival (DFS) was observed when pre-RT Hb<130.00 g/L. However, post-RT Hb<130.00 g/L was associated with significantly poorer 5-year locoregional recurrence-free survival (LRFS) (P=0.010) and disease specific survival (DSS) (P=0.008). Multivariate analysis with the COX proportional hazard model identified post-RT Hb<130.00 g/L as an independent negative prognostic factor for both LRFS (hazard ratio [HR], 1.896; 95% confidence interval [CI], 1.158-3.106; P=0.011) and DSS (HR, 1.767; 95% CI, 1.152-2.711; P=0.009). Similarly, △Hb <-15.00 g/L also predicted poorer 5-year LRFS (P=0.024) and DSS (P=0.015), which was confirmed in multivariate analysis as an independent adverse prognostic factor for LRFS (HR, 1.586; 95% CI, 1.058-2.377; P=0.026) and DSS (HR, 1.556; 95% CI, 1.087-2.227; P=0.016), respectively. Multivariate analysis with binary logistic regression model indicated that CCRT was a significantly independent predictor for post-RT Hb <130.00 g/L and △Hb < -15.00 g/L. Conclusions: Chemoradiotherapy-induced decreased Hb levels have negative influence on locoregional control and survival, and might counteract the benefit of neoadjuvant/concomitant chemotherapy. Further studies on supportive care to maintain sufficient Hb level during chemo-radiotherapy are warranted.
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Affiliation(s)
- Xue-Xia Liang
- 1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China. ; 3. Department of Radiation Oncology, the Fifth Affiliated Hospital of Sun Yat-sen University, 52 Meihua East Road, Zhuhai 519000, China
| | - Qun Li
- 1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China. ; 2. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China
| | - Zhen Su
- 1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China. ; 2. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China
| | - Xiao-Wen Lan
- 1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China. ; 2. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China
| | - Pu-Yun Ouyang
- 1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China. ; 2. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China
| | - Yan-Ping Mao
- 1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China. ; 2. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China
| | - Ding-Bo Shi
- 1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China
| | - Wu-Guo Deng
- 1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China
| | - Zhi-Bin Cheng
- 3. Department of Radiation Oncology, the Fifth Affiliated Hospital of Sun Yat-sen University, 52 Meihua East Road, Zhuhai 519000, China
| | - Si-Yang Wang
- 3. Department of Radiation Oncology, the Fifth Affiliated Hospital of Sun Yat-sen University, 52 Meihua East Road, Zhuhai 519000, China
| | - Fang-Yun Xie
- 1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China. ; 2. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China
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Hypoxia-related molecules HIF-1α, CA9, and osteopontin. Strahlenther Onkol 2012; 189:147-54. [DOI: 10.1007/s00066-012-0262-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 10/18/2012] [Indexed: 01/02/2023]
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