Hemoglobin Level as a Prognostic Factor of Neoadjuvant Chemoradiotherapy in Patients with Rectal Cancer

Introduction: This retrospective study aimed to determine the effect of pre-treatment hemoglobin (Hgb) value on the prognosis of patients with advanced rectal carcinoma undergoing neoadjuvant chemoradiotherapy (nCRT) in terms of pathologic complete response (pCR).Methods: A total of 192 individuals with rectal cancer who underwent nCRT were included in the study between 2011 and 2019.The patients were separated into anemic and non-anemic categories based on pretreatment Hgb values (Hgb <11 gr/dL).Results: The Hgb threshold for defining anemia was assessed using receiver operating characteristic curve analysis.Of the 48 (25%) patients, 144 (75%) were in the non-anemic group.The median overall survival (OS) time was 27 months in the anemic group and 69 months in the non-anemic group patients (p=0.028).No statistically significant difference was observed in disease-free survival between the groups.When comparing the two groups "patients" pCR and partial response ratio was elevated in the non-anemic group (p<0.001).In anemic groups patients, female, median age, >60 years, and CA19-9 value was high (p=0.021,p=0.042, p=0.014 and p=0.030).In logistic regression analysis for pCR, tumor regression grade (0-1 vs. 2-3) and pathologic T-stage (0 vs. 1-2) was statistically significant (p<0.001 and p=0.03), anemia (Hgb <11 gr/dL vs. >11 gr/dL) was not statistically significant (p=0.219). Conclusion:In the group with lower pretreatment Hgb values (<11 gr/dL), the pCR, partial response, and OS time were lower.However, Hgb levels with a cut-off of 11 gr/dL were not statistically proven to be prognostic factors for rectal carcinoma treated with nCRT.