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 neoadjuvant treatment. Patients were divided into four groups based on their admission hemoglobin (Hgb): group I: Hgb ≤ 12 g/dl, group II: Hgb = 12.1-12.9 g/dl, group III: Hgb = 13.0-14.0 g/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.