Purpose: A strong association between hemoglobin levels and tumor control exists in head and neck cancer treated with radiotherapy. This retrospective study has been performed to determine whether or not this association can also be found in the surgical setting.
Methods and materials: Between January 1970 and December 1990, 258 patients with glottic SCC received conventional surgery only (T1/T2/T3/T4 n = 188/31/37/2, respectively). Locoregional control was calculated by the Kaplan-Meier method. The influence of hemoglobin, T stage, age, gender, performance/nutritional status, and grading was evaluated using a Cox model.
Results: Five-year locoregional control for T1a/T1b/T2/T3/T4 tumors was 91%/85%/76%/62%/0%, respectively (log-rank test, p < 0.0001). Anemia (male < 13, female < 12 g/dL hemoglobin) was present in 27 patients. It was associated with significantly worse 5-year locoregional control, i.e., 60% vs. 85% (log-rank test, p = 0.003). In multivariate analysis stratified for T stage, two variables were of influence: positive margins (relative risk [RR], 3.8; 95% confidence interval [CI], 1.7-8.4), anemia (RR, 3.0; 95% CI, 1.4-6.2). The largest subgroup consisted of 162 patients characterized by male gender, T1, and complete resection. In this subgroup, the significant variables were T stage (T1b vs. T1a; RR, 3.5; 95% CI, 0.96-12.4) and hemoglobin with a RR of 1.4 (95% CI, 1.0-2.1) per g/dL less analyzed as a continuous variable.
Conclusion: Anemia is associated with a high risk of treatment failure in surgically treated glottic cancer. Hemoglobin levels might be predictive even within the normal range as indicated by subgroup analysis.