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Prognostic Value of Hemoglobin in Metastatic Hormone-sensitive Prostate Cancer: A Systematic Review and Meta-analysis
Keiichiro Mori1, Florian Janisch2, Hadi Mostafaei3
1Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
Insights
Low hemoglobin levels in metastatic hormone-sensitive prostate cancer (HSPC) patients are linked to poorer survival outcomes. This finding suggests hemoglobin testing could improve prognostic tools for HSPC.
Area of Science:
- Oncology
- Hematology
- Prognostic Biomarkers
Background:
- Prognostic factors for metastatic hormone-sensitive prostate cancer (HSPC) are crucial for treatment planning.
- Hemoglobin (Hb) levels may serve as a potential prognostic indicator in various cancers.
- The prognostic value of Hb in metastatic HSPC requires systematic evaluation.
Purpose of the Study:
- To assess the prognostic significance of hemoglobin (Hb) levels in patients diagnosed with metastatic hormone-sensitive prostate cancer (HSPC).
- To determine the association between low Hb levels and survival outcomes in metastatic HSPC.
- To evaluate Hb as a predictor for overall survival, cancer-specific survival, progression-free survival, and castration-resistant prostate cancer-free survival.
Main Methods:
- A systematic review and meta-analysis were conducted, searching PubMed, Web of Science, Cochrane Library, and Scopus databases.
- Eligible studies compared metastatic HSPC patients with normal versus low Hb levels.
- Meta-analyses were performed to pool hazard ratios (HR) for various survival endpoints.
Main Results:
- The meta-analysis included 21 studies with 5782 patients.
- Low Hb levels were significantly associated with worse overall survival (HR, 1.21), cancer-specific survival (HR, 1.46), progression-free survival (HR, 1.21), and castration-resistant prostate cancer-free survival (HR, 1.37).
- Low Hb was also linked to poorer overall survival in both high-volume (HR, 1.49) and low-volume (HR, 1.40) HSPC subgroups.
Conclusions:
- Low serum hemoglobin levels are associated with increased risks of mortality, disease progression, and recurrence in metastatic HSPC patients.
- Hemoglobin levels independently predict overall survival in both high-volume and low-volume metastatic HSPC.
- Incorporating Hb testing into prognostic models for metastatic HSPC may enhance clinical decision-making.
Abstract:
The purpose of this study was to assess the prognostic value of hemoglobin (Hb) in patients with metastatic hormone-sensitive prostate cancer (HSPC). The PUBMED, Web of Science, Cochrane Library, and Scopus databases were searched in December 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared patients with HSPC with normal and low Hb levels to determine their ability to predict overall survival, cancer-specific survival, progression-free survival, and castration-resistant prostate cancer-free survival. Formal meta-analyses were performed for these outcomes. The systematic review identified 25 studies including 6614 patients; 21 studies comprising 5782 patients were eligible for meta-analysis. Low Hb levels were associated with worse overall survival (pooled hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.15-1.29), cancer-specific survival (pooled HR, 1.46; 95% CI, 1.24-1.72), progression-free survival (pooled HR, 1.21; 95% CI, 1.14-1.28), and castration-resistant prostate cancer-free survival (pooled HR, 1.37; 95% CI: 1.18-1.57). Subgroup analyses revealed that low Hb levels were also associated with poor overall survival in patients with both "high-volume" (pooled HR, 1.49; 95% CI, 1.29-1.72) and "low-volume" HSPC (pooled HR, 1.40; 95% CI, 1.13-1.73). This meta-analysis revealed that low Hb serum levels in patients with metastatic HSPC were associated with increased risks of overall mortality, cancer-specific mortality, disease progression, and biochemical recurrence. Furthermore, Hb levels were independently associated with overall survival in the "high-volume" and "low-volume" HSPC subgroups. Therefore, it might be useful to incorporate Hb testing into prognostic tools for metastatic HSPC.
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