Influence of anemia on tumor response to preoperative chemoradiotherapy for locally advanced rectal cancer

Int J Colorectal Dis. 2009 Dec;24(12):1451-8. doi: 10.1007/s00384-009-0762-7. Epub 2009 Jul 7.


Purpose: In rectal cancer patients treated with preoperative chemoradiotherapy (CRT) and curative resection, we evaluated the influence of anemia on tumor response to preoperative CRT.

Methods: Between August 2001 and July 2007, 490 patients underwent preoperative CRT, followed by curative-intent surgery. Tumor responses were evaluated based on tumor regression grade (TRG), T- and N-level downstaging, and volume reduction rates.

Results: The level of pretreatment hemoglobin (Hb) was 12.9 +/- 1.7 g/dl (range, 7.2-17.6 g/dl). Tumor response rates were significantly different below and above the Hb level of 9.0 g/dl. Specifically, patients with Hb levels >or=9.0 g/dl achieved better tumor responses than those with Hb levels < 9.0 g/dl (rates of TRG 3 or 4-29.0% vs. 0%, p < 0.001). In addition, there is no differences in tumor response between the nontransfusion and transfusion groups of patients with Hb levels >or=9.0 g/dl (rates of TRG 3 or 4-29.1% vs. 23.1%, p = 0.445).

Conclusions: The serum Hb level could be a one of prognostic factors that influences the pathologic tumor response, and pretreatment anemia (below 9.0 g/dl of Hb) is associated with poor response to preoperative CRT.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anemia / complications*
  • Blood Transfusion
  • Female
  • Hemoglobins / metabolism
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Preoperative Care*
  • Prognosis
  • Rectal Neoplasms / complications
  • Rectal Neoplasms / drug therapy*
  • Rectal Neoplasms / pathology
  • Rectal Neoplasms / radiotherapy*
  • Remission Induction


  • Hemoglobins