Skip to main content
Springer Nature Link
Log in

Anemia is the strongest prognostic factor for outcomes of 5-fluorouracil-based first-line chemotherapy in patients with advanced gastric cancer

  • Original Article
  • Published:
Cancer Chemotherapy and Pharmacology Aims and scope Submit manuscript

Abstract

Objective: To examine the prevalence of anemia and its impact of hemoglobin (Hgb) levels in predicting outcomes of 5-fluorouracil (FU)-based first-line chemotherapy for patients with advanced gastric cancer (AGC). Methods: We collected data retrospectively from 511 consecutive patients treated with FU-based first-line chemotherapy as a routine clinical practice for AGC and followed up in two centers from 1995 to 2003. FU was given in combination with cisplatin (61%), taxanes (12%), anthracyclines (24%) and/or folinic acid (50%). Results: Hgb values were <10 g/dl in 41%, and patients with baseline Hgb levels <10 g/dl had significantly lower response rates (9%) than patients with Hgb≥10 g/dl (53%; P<0.001). In addition, Hgb<10 g/dl served as a predictor for disease progression (RR, 1.77; 95% CI, 1.42–2.21) and death (RR, 1.85; 95% CI, 1.48–2.32) along with chemotherapy response and performance status. Conclusion: Low baseline Hgb level is a strong and independent prognostic factor for the outcomes of AGC patients receiving FU-based first-line chemotherapy. This results strongly suggest that Hgb level, along with performance status, may be considered as a stratification variable in subsequent studies of AGC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bae JM, Won YJ, Jung KW, Park JG (2002) Annual report of the Korean central cancer registry program 2000. Cancer Res Treat 34:77–83

    Google Scholar 

  2. Pyrhonen S, Kuitunen T, Nyandoto P, Kouri M (1995) Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br J Cancer 71:587–591

    PubMed  CAS  Google Scholar 

  3. Glimelius B, Ekstrom K, Hoffman K, Graf W, Sjoden PO, Haglund U, Svensson C, Enander LK, Linne T, Sellstrom H, Heuman R (1997) Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol 8:163–168

    Article  PubMed  CAS  Google Scholar 

  4. Van Cutsem E (2004) The treatment of advanced gastric cancer: new findings on the activity of the taxanes. Oncologist 9(Suppl 2):9–15

    Article  PubMed  CAS  Google Scholar 

  5. Cullinan SA, Moertel CG, Wieand HS, O’Connell MJ, Poon MA, Krook JE, Mailliard JA, Tschetter LK (1994) Controlled evaluation of three drug combination regimens versus fluorouracil alone for the therapy of advanced gastric cancer. North Central Cancer Treatment Group. J Clin Oncol 12:412–416

    PubMed  CAS  Google Scholar 

  6. Ohtsu A, Shimada Y, Shirao K, Boku N, Hyodo I, Saito H, Yamamichi N, Miyata Y, Ikeda N, Yamamoto S, Fukuda H, Yoshida S (2003) Randomized phase III trial of fluorouracil alone versus fluorouracil plus cisplatin versus uracil and tegafur plus mitomycin in patients with unresectable, advanced gastric cancer: The Japan Clinical Oncology Group Study (JCOG9205). J Clin Oncol 21:54–59

    Article  PubMed  CAS  Google Scholar 

  7. Teicher BA, Holden SA, al-Achi A, Herman TS (1990) Classification of antineoplastic treatments by their differential toxicity toward putative oxygenated and hypoxic tumor subpopulations in vivo in the FSaIIC murine fibrosarcoma. Cancer Res 50:3339–3344

    PubMed  CAS  Google Scholar 

  8. Tannock IF (1987) Toxicity of 5-fluorouracil for aerobic and hypoxic cells in two murine tumours. Cancer Chemother Pharmacol 19:53–56

    Article  PubMed  CAS  Google Scholar 

  9. Cuvier C, Jang A, Hill RP (1997) Exposure to hypoxia, glucose starvation and acidosis: effect on invasive capacity of murine tumor cells and correlation with cathepsin (L + B) secretion. Clin Exp Metastasis 15:19–25

    Article  PubMed  CAS  Google Scholar 

  10. Graham CH, Forsdike J, Fitzgerald CJ, Macdonald-Goodfellow S (1999) Hypoxia-mediated stimulation of carcinoma cell invasiveness via upregulation of urokinase receptor expression. Int J Cancer 80:617–623

    Article  PubMed  CAS  Google Scholar 

  11. Hockel M, Schlenger K, Aral B, Mitze M, Schaffer U, Vaupel P (1996) Association between tumor hypoxia and malignant progression in advanced cancer of the uterine cervix. Cancer Res 56:4509–4515

    PubMed  CAS  Google Scholar 

  12. Hill RP, Bush RS, Yeung P (1971) The effect of anaemia on the fraction of hypoxic cells in an experimental tumour. Br J Radiol 44:299–304

    Article  PubMed  CAS  Google Scholar 

  13. Girinski T, Pejovic-Lenfant MH, Bourhis J, Campana F, Cosset JM, Petit C, Malaise EP, Haie C, Gerbaulet A, Chassagne D (1989) Prognostic value of hemoglobin concentrations and blood transfusions in advanced carcinoma of the cervix treated by radiation therapy: results of a retrospective study of 386 patients. Int J Radiat Oncol Biol Phys 16:37–42

    PubMed  CAS  Google Scholar 

  14. Grogan M, Thomas GM, Melamed I, Wong FL, Pearcey RG, Joseph PK, Portelance L, Crook J, Jones KD (1999) The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix. Cancer 86:1528–1536

    Article  PubMed  CAS  Google Scholar 

  15. Obermair A, Cheuk R, Horwood K, Janda M, Bachtiary B, Schwanzelberger B, Stoiber A, Nicklin JL, Perrin LC, Crandon AJ (2001) Impact of hemoglobin levels before and during concurrent chemoradiotherapy on the response of treatment in patients with cervical carcinoma: preliminary results. Cancer 92:903–908

    Article  PubMed  CAS  Google Scholar 

  16. Lee WR, Berkey B, Marcial V, Fu KK, Cooper JS, Vikram B, Coia LR, Rotman M, Ortiz H (1998) Anemia is associated with decreased survival and increased locoregional failure in patients with locally advanced head and neck carcinoma: a secondary analysis of RTOG 85–27. Int J Radiat Oncol Biol Phys 42:1069–1075

    PubMed  CAS  Google Scholar 

  17. Dubray B, Mosseri V, Brunin F, Jaulerry C, Poncet P, Rodriguez J, Brugere J, Point D, Giraud P, Cosset JM (1996) Anemia is associated with lower local-regional control and survival after radiation therapy for head and neck cancer: a prospective study. Radiology 201:553–558

    PubMed  CAS  Google Scholar 

  18. Kumar P, Wan J, Viera F (1997) Analysis of survival outcome and prognostic factors in the treatment of unresectable head and neck squamous cell carcinoma using supra-dose intra-arterial targeted cisplatin and concurrent radiotherapy. Proc Am Soc Clin Oncol 16:390a (abstr 1394)

    Google Scholar 

  19. Rizzo JD, Lichtin AE, Woolf SH, Seidenfeld J, Bennett CL, Cella D, Djulbegovic B, Goode MJ, Jakubowski AA, Lee SJ, Miller CB, Rarick MU, Regan DH, Browman GP, Gordon MS (2002) Use of epoetin in patients with cancer: evidence-based clinical practice guidelines of the American Society of Clinical Oncology and the American Society of Hematology. J Clin Oncol 20:4083–4107

    Article  PubMed  CAS  Google Scholar 

  20. Miller AB, Hoogstraten B, Staquet M, Winkler A (1981) Reporting results of cancer treatment. Cancer 47:207–214

    Article  PubMed  CAS  Google Scholar 

  21. Ludwig H, Van Belle S, Barrett-Lee P, Birgegard G, Bokemeyer C, Gascon P, Kosmidis P, Krzakowski M, Nortier J, Olmi P, Schneider M, Schrijvers D (2004) The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer 40:2293–2306

    Article  PubMed  Google Scholar 

  22. Bokemeyer C, Oechsle K, Hartmann JT, Schoffski P, Schleucher N, Metzner B, Schleicher J, Kanz L (2002) Treatment-induced anaemia and its potential clinical impact in patients receiving sequential high dose chemotherapy for metastatic testicular cancer. Br J Cancer 87:1066–1071

    Article  PubMed  CAS  Google Scholar 

  23. Kelleher DK, Matthiensen U, Thews O, Vaupel P (1995) Tumor oxygenation in anemic rats: effects of erythropoietin treatment versus red blood cell transfusion. Acta Oncol 34:379–384

    Article  PubMed  CAS  Google Scholar 

  24. Sundfor K, Lyng H, Kongsgard UL, Trope C, Rofstad EK (1997) Polarographic measurement of pO2 in cervix carcinoma. Gynecol Oncol 64:230–236

    Article  PubMed  CAS  Google Scholar 

  25. Bokemeyer C, Aapro MS, Courdi A, Foubert J, Link H, Osterborg A, Repetto L, Soubeyran P (2004) EORTC guidelines for the use of erythropoietic proteins in anaemic patients with cancer. Eur J Cancer 40:2201–2216

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Internal Medicine, Gachon Medical School Gil Medical Center, Incheon, 405-760, Korea

    Se Hoon Park, Soo Mee Bang, Eun Kyung Cho, Dong Bok Shin & Jae Hoon Lee

  2. Division of Hematology and Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea

    Jeeyun Lee, Se Hoon Lee, Joon Oh Park, Kihyun Kim, Won Seog Kim, Chul Won Jung, Young Suk Park, Won Ki Kang & Keunchil Park

  3. Center for Biostatistics, Samsung Biomedical Research Institute, Seoul, Korea

    Seonwoo Kim

Authors
  1. Se Hoon Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeeyun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Se Hoon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joon Oh Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kihyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Won Seog Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chul Won Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Young Suk Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Won Ki Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Keunchil Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Seonwoo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Soo Mee Bang
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Eun Kyung Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Dong Bok Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Jae Hoon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dong Bok Shin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Park, S.H., Lee, J., Lee, S.H. et al. Anemia is the strongest prognostic factor for outcomes of 5-fluorouracil-based first-line chemotherapy in patients with advanced gastric cancer. Cancer Chemother Pharmacol 57, 91–96 (2006). https://doi.org/10.1007/s00280-005-0027-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00280-005-0027-2

Keywords