Anemia independent predictor of decreased disease-specific survival in endometrial cancer: Study Study

Endometrial cancer (EC) is the leading gynecologic cancer in industrialized nations, and its occurrence is increasing as a result of population aging and higher rates of obesity. Recently published large retrospective multicenter cohort study evaluated the relationship between preoperative hematological parameters (anemia, thrombocytosis, leucocytosis) and clinicopathological characteristics, risk groups, and survival outcomes in 894 endometrial cancer patients. It also explored the predictive value of these parameters on response to adjuvant radiotherapy.

Findings on Anemia, Thrombocytosis, and Leucocytosis

The study found that anemia was present in 11.5% of patients, thrombocytosis in 8.8%, and leucocytosis in 12.7%. The presence of anemia or thrombocytosis was significantly associated with the high-risk ESGO/ESTRO/ESP risk group. In the overall cohort, anemia remained an independent predictor of decreased disease-specific survival after adjusting for age, abnormal hematological parameters, and risk groups.

Impact on Radiotherapy

In the 239 patients who received adjuvant radiotherapy, anemia was associated with significantly reduced 5-year disease-specific and recurrence-free survival. Furthermore, in the 74 patients classified as ESGO/ESTRO/ESP intermediate-risk who received only vaginal brachytherapy, anemia was associated with reduced disease-specific survival.

Significance of Anemia

These results demonstrate the important prognostic value of preoperative anemia in endometrial cancer, which appears to be an independent predictor of worse outcomes. Notably, anemia also seemed to be associated with reduced response to radiotherapy, particularly in the intermediate-risk group receiving only vaginal brachytherapy.

Future Research Implications

The authors hypothesize that anemia may reflect more aggressive tumor biology or tumor hypoxia, which could impact radiotherapy efficacy. They conclude that prospective validation in a larger cohort is needed to further evaluate anemia as a predictive biomarker for radiotherapy response in endometrial cancer. Understanding the relationship between preoperative hematological parameters, tumor characteristics, and treatment response could help guide personalized management strategies for endometrial cancer patients.

Key Points

1. This large retrospective multicenter cohort study evaluated the relationship between preoperative hematological parameters (anemia, thrombocytosis, leucocytosis) and clinicopathological characteristics, risk groups, and survival outcomes in 894 endometrial cancer patients. It also explored the predictive value of these parameters on response to adjuvant radiotherapy.

2. The study found that anemia was present in 11.5% of patients, thrombocytosis in 8.8%, and leucocytosis in 12.7%. The presence of anemia or thrombocytosis was significantly associated with the high-risk ESGO/ESTRO/ESP risk group. In the overall cohort, anemia remained an independent predictor of decreased disease-specific survival after adjusting for age, abnormal hematological parameters, and risk groups.

3. In the 239 patients who received adjuvant radiotherapy, anemia was associated with significantly reduced 5-year disease-specific and recurrence-free survival. Furthermore, in the 74 patients classified as ESGO/ESTRO/ESP intermediate-risk who received only vaginal brachytherapy, anemia was associated with reduced disease-specific survival.

4. These results demonstrate the important prognostic value of preoperative anemia in endometrial cancer, which appears to be an independent predictor of worse outcomes. Notably, anemia also seemed to be associated with reduced response to radiotherapy, particularly in the intermediate-risk group receiving only vaginal brachytherapy.

5. The authors hypothesize that anemia may reflect more aggressive tumor biology or tumor hypoxia, which could impact radiotherapy efficacy. They conclude that prospective validation in a larger cohort is needed to further evaluate anemia as a predictive biomarker for radiotherapy response in endometrial cancer.

6. Understanding the relationship between preoperative hematological parameters, tumor characteristics, and treatment response could help guide personalized management strategies for endometrial cancer patients.

Reference –

Stephanie W. Vrede, Hannah Donkers, Casper Reijnen, Anke Smits, Nicole C.M. Visser, Peggy M. Geomini, Huy Ngo, Dennis van Hamont, Brenda M. Pijlman,Maria Caroline Vos, Marc P.L.M. Snijders, Roy Kruitwagen, Ruud L.M. Bekkers, Khadra Galaal & Johanna M.A. Pijnenborg (2024) Abnormal preoperative haematological parameters in Endometrial cancer; reflecting tumour aggressiveness or reduced response to radiotherapy?,

Journal of Obstetrics and Gynaecology, 44:1, 2294332, DOI: 10.1080/01443615.2023.2294332