Z Gastroenterol 2014; 52 - P_4_44
DOI: 10.1055/s-0033-1360997

Single measurement of hemoglobin predicts outcome of HCC patients

F Finkelmeier 1, D Bettinger 2, V Köberle 1, M Schultheiß 2, B Kronenberger 1, A Piiper 1, O Waidmann 1
  • 1Universitätsklinikum Frankfurt, Medizinische Klinik 1 – Schwerpunkt Gastroenterologie und Hepatologie, Frankfurt am Main, Germany
  • 2Universitätsklinik Freiburg, Medizinische Klinik II, Freiburg, Germany

Objective:

Cancer related anemia is a common complication in nearly all types of cancer. Beside the symptoms of fatigue, breathlessness, loss of mental acuity, anemia also significantly impairs quality of life and has been shown to be an important adverse factor for survival in different cancer entities as well as liver cirrhosis. However, the prognostic potential of hemoglobin has not yet been investigated in patients with hepatocellular carcinoma (HCC). Therefore we performed prospective cohort study in two independent cohorts investigating the relation of hemoglobin (Hb) levels and overall survival (OS).

Methods:

From February 2009 to March 2013, 199 patients with confirmed HCC presenting at the Department of Internal Medicine 1 of the Frankfurt University Hospital outpatient clinic were consecutively enrolled into the present prospective cohort study. Patient characteristics, treatment, and outcome was entered into a prospectively conducted database. Blood samples were obtained at the day of study inclusion. Patients were followed until death or last contact. The primary end point was overall survival (OS). For validation a second cohort of patients recruited at the University Hospital Freiburg was used.

Results:

The mean follow-up time was 323 + 342 days with a range of 1 – 1508 days. 18 patients underwent liver transplantation and 57 (28.6%) patients died within the observation time. The mean Hb level was 12.3 +/-2.1 g/dl with a range of 7.3.-16.9 g/dl. Hb levels significantly differed between Child Pugh stages and showed a negative correlation with the MELD score. There were significant differences between stages of HCC according to the BCLC staging system. Patients with Hb level ≤13 g/dl had a significantly shorter OS (hazard ratio (HR) 2.422, (CI) 1.357 – 4.322, P = 0.003). In a multivariate Cox regression model low Hb levels (≤13 g/dl) and high CRP levels (> 0.5 mg/dl) were independently associated with higher mortality. In a second, independent cohort of 87 patients Hb level ≤13 g/dl were also associated with a shorter OS.

Conclusion:

We were able to show that anemia correlates with the prognosis of HCC patients and could be considered as an easy accessible additional risk factor for mortality.