Background and objective: Cancer-related anemia is the common complication of non-small cell lung cancer (NSCLC), which affects the quality of life (QOL), chemotherapy efficacy and prognosis in patients with NSCLC. In this study, we statistically analysed the incidence of anemia in NSCLC patients before and after chemotherapy and related risk factors, and investigated the impact of anemia on QOL, chemotherapy efficacy and prognosis in patients with NSCLC.
Methods: Clinical data of 140 patients with NSCLC from January 2007 to December 2008 were collected and retrospectively analysed for the changes in hemoglobin levels before and after chemotherapy, the risk factors of anemia, and the relationship with chemotherapy efficacy and prognosis. Application of QOL scale (EORTCQLQ-C30, Chinese version) to evaluate the impact of anemia on QOL in patients with advanced NSCLC.
Results: Total 140 cases of NSCLC patients, the incidence of anemia after two cycles of chemotherapy was significantly higher than that before chemotherapy (71.4% vs 47.1%, P < 0.001), and the severity of anemia increased simultaneously with the cycles of chemotherapy. According to univariete and multivariate Logstic regression analysis, age, clinical stage, PS score and albumin levels were closely related to pre-treatment cancerrelated anemia. However, multivariate Logistic regression analysis confirmed that only albumin levels was the risk factors of anemia. QOL scores on physical function, symptoms and overall quality of life were significantly different in anemia and nonanemic patients (P < 0.05). Anemia occurred before and after chemotherapy were significantly lower chemotherapy efficacy in patients with advanced NSCLC. Cancer-related anemia obviously impacted on the prognosis of patients, the median survival of cancer-related anemia patients was significantly shorter than those without anemia (7 months vs 13 months, P < 0.001), and the median survival of cancer-related anemia patients before chemotherapy was significantly longer than those with anemia (7 months vs 11 months, P < 0.001). Cox multivariate regression analysis confirmed that anemia, clinical stage, PS score, albumin level were the independent prognostic factors in advanced NSCLC.
Conclusions: NSCLC patients had a higher incidence of anemia, especially the incidence of chemotherapy-related anemia, age, clinical stage, PS score, albumin levels were the risk factors of pre-treatment cancer-related anemia. NSCLC patients with anemia had lower QOL and chemotherapy efficacy, and shorter lifetime. Anemia was an independent prognostic factor in NSCLC patients.
背景与目的: 癌性贫血是非小细胞肺癌（non-small cell lung cancer, NSCLC）的常见并发症，不但严重影响NSCLC患者的生活质量（quality of life, QOL），还影响其化疗疗效和预后，本研究通过统计NSCLC患者化疗前后贫血发生率，分析其危险因素，探讨贫血对NSCLC患者QOL及化疗疗效和预后的影响。
方法: 回顾性分析我院2007年1月-2008年12月期间住院的140例NSCLC患者化疗前后血红蛋白水平变化，探讨发生贫血的危险因素，分析其与化疗疗效、预后的关系；并应用QOL量表EORTCQLQ-C30中文版评价贫血对NSCLC患者QOL的影响。
结果: 140例NSCLC患者，化疗2周期后贫血发生率明显高于化疗前（71.4% vs 47.1%, P < 0.001），贫血严重程度随着化疗周期的增加而加重。单因素和多因素Logistic回归分析显示，年龄、临床分期、PS评分、白蛋白水平与治疗前发生癌性贫血密切相关；而多因素Logistic分析显示，仅白蛋白水平是引发治疗后贫血的危险因素。贫血者与非贫血者的QOL量表得分在症状、躯体功能及整体生活质量均有显著差异（P < 0.05）。无论化疗前发生的贫血还是化疗导致的贫血均显著降低NSCLC患者化疗的疗效。癌性贫血严重影响患者的预后，发生癌性贫血者的中位生存期明显短于无贫血者（7个月vs 13个月，P < 0.001）；化疗前就发生癌性贫血者的中位生存期亦明显短于化疗前无贫血者（7个月vs 11个月，P < 0.001）。Cox多因素回归分析证实，贫血、临床分期、PS评分、白蛋白水平是影响NSCLC患者预后的独立因素。
结论: NSCLC患者有较高的贫血尤其是化疗相关性贫血的发生率，年龄、临床分期、PS评分、白蛋白水平是引发治疗前癌性贫血的危险因素。贫血不但降低NSCLC患者的QOL、降低化疗疗效，还缩短其生存期，是影响预后的独立因素。