Prognostic implications of hemoglobin levels before and after surgery as well as before and after radiochemotherapy for XXXX .

@entity1 @entity135 @entity5 @entity190 @entity26 @entity900 @entity519 @entity3
Several studies have shown that @entity5 cells may develop resistance to radiotherapy, proliferating under @entity519 conditions. Following surgery, @entity1 may develop low hemoglobin levels, which may cause low @entity26 conditions. This retrospective analysis was undertaken to determine the impact of low hemoglobin levels in @entity1 with @entity135 treated with combined-modality therapy (surgery and postoperative radiochemotherapy). We studied 120 @entity1 with mostly advanced @entity135 (88% stage III/IV) who had undergone macroscopically complete resections of their primary @entity5 and lymph node @entity3 . At 20-277 days after surgery (median: 51.3 days), these @entity1 received postoperative chemoradiotherapy (56.7 Gy of radiation over 28-49 days and @entity900 6 mg/m(2) body surface area on radiation treatment days with a cumulative dose of 96 mg/m(2)). Normal hemoglobin levels were considered to be 12 g/dl for females and 13 g/dl for males. Decreased hemoglobin levels before or after surgery and before or after chemoradiotherapy were correlated with the prognosis. Preoperatively, 99 of 114 @entity1 (87%) had normal levels of hemoglobin compared with only 20 of 107 @entity1 (19%) postoperatively. At the onset of radiochemotherapy, the hemoglobin levels of 82 of 116 @entity1 (71%) were within the normal range. After radiochemotherapy, however, 62 of 114 @entity1 (54%) had normal hemoglobin levels. Univariate analysis (Kaplan-Meier method and log-rank test) showed that @entity1 with decreased pre- or postoperative hemoglobin levels had significantly worse locoregional control ( P=0.032 and P=0.0001, respectively) and lower overall survival ( P=0.0013 and P=0.0002, respectively) than @entity1 with normal hemoglobin levels. The 3-year locoregional control rates in @entity1 with preoperative hemoglobin levels that were normal, were reduced by 1-2 g/dl or were reduced by more than 3 g/dl, respectively, were 78%, 55% and 50%. Correlated with normal and diminished postoperative hemoglobin levels, the 3-year locoregional control rates were 90%, 84% and 50%, respectively. There was no correlation between prognosis and hemoglobin level at the onset or after radiochemotherapy. On multivariate analysis, only the postoperative hemoglobin level remained a prognostic factor for locoregional control ( P=0.0241) and overall survival ( P=0.0080). We conclude that low postoperative hemoglobin levels resulting from @entity190 may influence the efficacy of postoperative radiochemotherapy in @entity1 with @entity135 . Early intervention to raise the postoperative hemoglobin level may result in @entity5 control and overall survival after combined-modality therapy.
