Anaemia and its effects on tumour regression grade and survival following chemotherapy in adenocarcinoma of the oesophagus.

BACKGROUND: Anaemia reduces the efficacy of chemotherapy in gastric cancer. However, it has not been studied in oesophageal cancer. We investigated whether anaemia impacts on survival and the efficacy of chemotherapy, in adenocarcinoma of the oesophagus for those undergoing neoadjuvant chemotherapy and then surgical resection. METHODS: This prospective study included 268 patients who received neoadjuvant chemotherapy for oesophageal adenocarcinoma. Patient clinical data as well as Mandard's tumor regression grading (TRG), haemoglobin pre-chemotherapy and during the chemotherapy were compiled. The association between anaemia and TRG was tested using Chi-squared analysis, whilst survival outcomes were investigated by Kaplan-Meier and Cox regression. RESULTS: One hundred participants were anaemic before chemotherapy whilst 224 were anaemic during chemotherapy cycles. Survival analyses found a significant association between lower haemoglobin levels and decreased overall survival (P=0.048). Comparing those without anaemia against those with moderate -severe anaemia (<10.9 g/dL) found a statistically significant association in overall survival (P=0.026). Multivariate cox regression showed those with anaemia were statistically more likely to have decreased overall survival (HR 1.735, 95% CI, 1.050-2.867, P=0.032). No statistical association was seen between those with pre-chemotherapy anaemia and TRG (OR 0.675, 95% CI, 0.420-1.161, P=0.130) or those with anytime anaemia (OR 0.881, 95% CI, 0.406-1.914, P=0.931). CONCLUSIONS: These results suggest that anaemia is associated with poorer overall survival time, with lower haemoglobin levels reducing prognosis. However, there does not appear to be an association between anaemia and chemotherapy response in oesophageal adenocarcinoma.