Does anemia affect outcome after lobectomy or pneumonectomy in early stage lung cancer patients who have not received neo-adjuvant treatment?

Backround: Preoperative anemia has been shown to be an ominous prognostic factor for survival in patients with early stage non small cell lung cancer. Methods: Two hundred and fourteen patients underwent resection for early stage non small cell lung cancer between 2001 and 2006 without neo-adjuvant treatment. Patients were divided into four groups based on their admission hemoglobin (Hgb): group I: Hgb <= 12 g/dl, group II: Hgb = 12.1-12.9g/dl, group III: Hgb=13.0-14.0g/dl, and group IV: Hgb > 14 g/dl. Cox regression analysis was used to evaluate each variable's impact on midterm survival taking all causes and lung cancer-specific mortality into account. Kaplan-Meier survival plots were estimated. Results: Preoperative hemoglobin (HR = 1.44,95 % confidence intervals 1.08 - 1.94, p = 0.014) and pneumonectomy (HR=3.58, 95% confidence intervals 1.26 - 10.16, p = 0.017) were the only predictors of all-cause midterm mortality. Similarly, when only lung cancer-related mortality was considered, preoperative hemoglobin (HR = 1.81, 95 % confidence intervals 1.17-2.78, p=0.007) and pneumonectomy (HR = 6.89, 95 % confidence intervals 2.29 - 20.73, p = 0.001,) were independent predictors. Age, gender, pulmonary function test results, tumor stage, and histology did not influence survival. Conclusions: Preoperative anemia and the type of resection in early stage non small cell lung cancer have an impact on midterm survival and lung cancer-specific mortality.