scholarly journals A Risk Stratification Model Based on a Population Analysis for Predicting Cancer Specific Survival in Pediatric Brain Stem Glioma.

2021 ◽  
Author(s):  
Kai Sun ◽  
Xiaowei Fei ◽  
Mingwei Xu ◽  
Wenjin Chen ◽  
Ruxiang Xu
Keyword(s):  
Multivariate Analysis ◽  
Risk Stratification ◽  
Cox Regression ◽  
Population Analysis ◽  
Brainstem Glioma ◽  
Prognostic Indicators ◽  
Brain Stem Glioma ◽  
Clinicopathologic Characteristics ◽  
Cancer Specific Survival ◽  
Risk Stratification Model

Introduction: The aim of this study was to construct and validate a nomogram and risk stratification model for predicting cancer-specific survival (CSS) of pediatric brainstem glioma patients. Methods: Cases of pediatric brainstem glioma patients (<12 years) from 1998 to 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database and demographic, clinicopathologic characteristics, treatments, and survival outcomes were analyzed. The total cohort was randomly divided into training and validation sets, followed by univariate and multivariate Cox regression analyses. A nomogram was constructed and risk stratification analysis incorporated using the selected variables from the multivariate analysis. The accuracy of the model was assessed using C-index and calibration curves. Results: A total of 806 pediatric cases with histologically confirmed diagnosis of brainstem glioma were selected and analyzed. Multivariate analysis showed that age, race, tumor size, grade and radiotherapy (P<0.05) were independent prognostic indicators of pediatric gliomas. For prediction of CSS, the C-index of the nomogram was 0.75, which shows a good predictive probability. Conclusion: The nomogram developed in this study for predicting survival of pediatric patients with histologically confirmed stem gliomas is the first to incorporate risk stratification. Combining nomogram and risk stratification system is a convenient tool to aid clinicians in the identification of high-risk patients and to perform targeted adjuvant treatment.

scholarly journals Development and Validation of Prognostic Nomograms for Patients with Parotid Gland Adenocarcinoma Not Otherwise Specified: A SEER Analysis From 2004 To 2016

2021 ◽  
Author(s):  
Zi-Meng Wang ◽  
Zuo-Lin Xiang
Keyword(s):  
Parotid Gland ◽  
Prediction Models ◽  
Cox Regression ◽  
Clinicopathological Characteristics ◽  
Prognostic Indicators ◽  
Regression Analyses ◽  
Cancer Specific Survival ◽  
T Stage ◽  
Not Otherwise Specified ◽  
N Stage

Abstract Background Parotid gland adenocarcinoma not otherwise specified (PANOS) is a rare malignancy, and the characteristics and prognosis of this disease remain unclear. This study aims to characterize PANOS and establish prognostic prediction models for patients with PANOS. Methods Cases from 2004–2016 were retrieved from the Surveillance, Epidemiology, and End Results Program database (SEER database). Univariate and multivariate Cox regression analyses, Gray's test and propensity score matching (PSM) were conducted to analyze demographics, treatments, and survival outcomes . Results The 446 patients ( 289 men) selected for analysis had a median age of 66 (19–95) years, and 307 patients were diagnosed with stage III/IV disease. The median survival of all patients was 66 months, with a 51.8% 5-year overall survival (OS) rate. Surgical treatment clearly improved survival time (p < 0.001). In the subgroup analysis, radiotherapy showed survival benefits in patients with advanced-stage disease (III/IV) (p < 0.001). Multivariate Cox regression analyses revealed that age, T stage, N stage, M stage and surgery were independent prognostic indicators for OS;T stage, N stage, M stage and surgery were independent risk factors for cancer-specific survival(CSS).In addition, age was independently associated with noncancer-related death. Two nomograms were established based on the results of the multivariate analysis, which was validated by the concordance index (C-index) (0.747 and 0.780 for OS and CSS, respectively) and the area under the time-dependent receiver operating characteristic(ROC) curve(0.756, 0.764 and 0.819 regarding for nomograms predicting 3-, 5- and 10- year OS, respectively and 0.794, 0.789 and 0.806 for CSS, respectively). Conclusions Our study clearly presents the clinicopathological characteristics and survival analysis of patients with PANOS. In addition, our constructed nomogram prediction models may assist physicians in evaluating the individualized prognosis and deciding on treatment for patients.

scholarly journals A novel risk stratification for predicting prognosis of colorectal cancer patients with bone metastasis

2020 ◽  
Author(s):  
Chenxi Ma ◽  
Xu Guan ◽  
Jichuan Quan ◽  
Zhixun Zhao ◽  
Haipeng Chen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Bone Metastasis ◽  
Risk Stratification ◽  
Scoring System ◽  
Clinical Decision Making ◽  
Cox Regression ◽  
Tumor Resection ◽  
Cancer Specific Survival ◽  
Discrimination Power

Abstract Backgroud: Our understanding in prognosis of bone metastasis (BM) from colorectal cancer (CRC) is limited. We aimed to establish a clinical risk stratification for individually predicting the survival of CRC patients with BM.Methods: A total of 200 CRC patients with BM were included in this study. Survival time from BM diagnosis was estimated using the Kaplan-Meier method. The multivariable COX regression model identified the risk factors on cancer specific survival (CSS). Based on weighted scoring system, the stratification model was constructed to classify patients with BM according to prognostic risk. Discrimination power and calibration ability of risk stratification were measured.Results: The median CSS time was 11 months after BM diagnosis. Lymph node metastasis, CA199 levels, bone involvement, KPS scores, primary tumor resection, bisphosphonates therapy and radiotherapy were identified as predictors of CSS. Four risk groups were stratified according to weighted scoring system, including low risk, medium risk, medium-high risk and high risk group, with 35, 16, 9 and 5 months of median CSS, respectively (P = 0.000). The risk stratification displayed good accuracy in predicting CSS, with acceptable discrimination and calibration.Conclusion: This novel risk stratification predicts CSS in CRC patient with BM using easily accessible clinicopathologic factors, which is recommended for use in individualized clinical decision making in patient with BM.

scholarly journals Establishment and Validation of Prognostic Nomograms for Patients With Parotid Gland Adenocarcinoma Not Otherwise Specified: A SEER Analysis From 2004 to 2016

2022 ◽  
Vol 8 ◽  
Author(s):  
Zi-Meng Wang ◽  
Zuo-Lin Xiang
Keyword(s):  
Parotid Gland ◽  
Survival Time ◽  
Prediction Models ◽  
Cox Regression ◽  
Stage Iii ◽  
Prognostic Indicators ◽  
Cancer Specific Survival ◽  
Not Otherwise Specified ◽  
N Classification ◽  
T Classification

Background: Parotid gland adenocarcinoma not otherwise specified (PANOS) is a rare malignant tumor with limited data on its characteristics and prognosis. This research is aimed at characterizing PANOS and developing prognostic prediction models for patients with PANOS.Methods: Cases from 2004–2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) Program database. Univariate and multivariate Cox regression were applied to ascertain the factors associated with survival. Competing risk analysis and Gray's tests were employed to analyze cancer-specific death. Propensity score matching (1:1) was conducted to reduce the influence of confounding variables.Results: A total of 446 patients with a median age of 66 years were selected, of which 307 were diagnosed with stage III/IV PANOS. The 5-year overall survival (OS) rate of all patients was 51.8%, and the median survival time was 66 months. Surgical treatment clearly improved survival time (p &lt; 0.001). In the subgroup analysis, radiotherapy showed survival benefits in patients with stage III/IV disease (p &lt; 0.001). Multivariate Cox regression analyses showed that age, T classification, N classification, M classification and surgery were independent prognostic indicators for OS; T classification, N classification, M classification and surgery were independent risk factors for cancer-specific survival (CSS). In addition, age was independently associated with other cause-specific death. Based on the results of multivariate analysis, two nomograms were developed and verified by the concordance index (C-index) (0.747 and 0.780 for OS and CSS) and the area under the time-dependent receiver operating characteristic (ROC) curve (0.756, 0.764, and 0.819 regarding for nomograms predicting 3-, 5-, and 10- year OS, respectively and 0.794, 0.789, and 0.806 for CSS, respectively).Conclusions: Our study clearly presents the clinicopathological features and survival analysis of patients with PANOS. In addition, our constructed nomogram prediction models may assist physicians in evaluating the individualized prognosis and deciding on treatment for patients.

Residual pathologic stage at radical cystectomy and risk stratification of patients with pT2N0 bladder cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5076-5076
Author(s):  
H. Isbarn ◽  
G. Sonpavde ◽  
S. F. Shariat ◽  
G. S. Palapattu ◽  
A. I. Sagalowsky ◽  
...  
Keyword(s):  
High Risk ◽  
Urinary Bladder ◽  
Adjuvant Therapy ◽  
Risk Stratification ◽  
Radical Cystectomy ◽  
Cox Regression ◽  
Transitional Cell ◽  
Invasive Disease ◽  
Cancer Specific Survival ◽  
Muscle Invasive

5076 Background: We hypothesized that in patients with pT2N0 transitional cell carcinoma (TCC) of the urinary bladder, residual muscle-invasive disease at radical cystectomy (RC) may confer poorer outcomes than residual non-muscle invasive disease due to larger tumor volume and/or biologically more aggressive disease. Patients with high-risk pT2N0 disease may be candidates for trials of adjuvant therapy. Methods: Patients from the BCRC database with pT2N0 stage (N = 208) at TUR (transurethral resection) whose tumors were organ-confined at RC (≤pT2N0) were analyzed. T1N0 patients (N=33) with pT2 disease at RC were also examined in order to include all pT2 patients. None of the patients had received perioperative chemotherapy. The effect of residual pT-stage at RC on outcomes was evaluated in Kaplan-Meier, as well as in univariable and multivariable Cox-regression models. Covariates consisted of age, gender, grade, lymphovascular invasion, concomitant carcinoma-in-situ (CIS), number of lymph nodes removed, and the year of surgery. Results: Among baseline T2N0 patients, residual pT-stage at RC was pT0 in 24 (11.5%), pTa in 9 (4.3%), pCIS in 22 (10.6%), pT1 in 35 (16.8%), and pT2 in 118 patients (56.7%). The median follow-up was 50.1 months. The 5-year recurrence-free survivals of patients with residual pT0/pTa/pCis, pT1 and pT2 were 100%, 85% and 75%, respectively. The 5-year cancer-specific survival rates for the same patient cohorts were 100%, 93%, and 81%, respectively. In multivariable analyses, the effect of residual stage <pT2 at RC achieved independent predictor status for recurrence (adjusted HR 0.20; p = 0.002), as well as for cancer-specific survival (adjusted HR: 0.24; p = 0.02). Initial T1 patients who were pT2 at RC did not have statistically different outcomes compared to initial T2 followed by pT2 at RC. Conclusions: Patients with pT2N0 TCC of the urinary bladder with residual non-muscle invasive disease at RC have significantly better long-term outcomes compared to residual muscle-invasive disease. With further validation, these data may facilitate the risk-stratification of patients with pT2N0 disease and enable the selection of high-risk patients for trials of adjuvant therapy. No significant financial relationships to disclose.

Development of a new outcome-prediction model for patients with urothelial carcinoma of the bladder prior to cystectomy.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 360-360
Author(s):  
Mario W. Kramer ◽  
Christoph A. J. von Klot ◽  
Annika Heinisch ◽  
Gerd Wegener ◽  
Mahmoud Abbas ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Multivariate Analysis ◽  
Risk Stratification ◽  
Serum Creatinine ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Blood Cells ◽  
White Blood Cells ◽  
Scoring Model ◽  
Risk Stratification Model

360 Background: Prognostic models for patients undergoing cystectomy are spares and mostly rely on histopathological parameters. The present study investigated clinical prognostic indicators that are available prior to cystectomy for developing a risk stratification model. Methods: Charts were reviewed from 279 bladder cancer patients that were treated with radical cystectomy and bilateral lymphadenectomy. Of those 194 were eligible for study entry due to availability of necessary data. None of the patients had neoadjuvant therapy. Various preoperative parameters were analyzed and optimum cut-off points were identified using ROC curves. A risk stratification model was developed based on multivariate analysis. Analyzed factors included serum-creatinine, hemoglobin, white blood cells, C - reactive protein (CRP), age, gender, and body mass index. Results: In multivariate analysis, preoperative serum-creatinine (>93 umol/l), white blood cells (>10.2 tsd/ul), CRP (>3 mg/l) and BMI (<18,5 kg/m2 or ≥30 kg/m2) were independent predictor of poor cancer-specific survival (CSS). A new scoring model was developed, consisting of those four parameters. The stratification model showed significant differences based on Kaplan-Meier analysis for the whole cohort as well as for subgroup analysis (pT2-4, Nx, M0) (p<0.001). CSS after 36 (60) months for low, intermediate and high risk group was 82.6% (76.2%), 37.7% (30.9%) and 22.2% (16.7%), respectively (p<0.0001). Conclusions: Our scoring model based on preoperative clinical parameters can discriminate bladder cancer patients prior to cystectomy in respect of CSS. This might help physicians to recommend treatment options such as neoadjuvant therapy. The scoring model needs external validation considering prospective study design and discriminating patients who received neoadjuvant chemotherapy.

scholarly journals The AST/ALT (De Ritis) Ratio Predicts Survival in Patients with Oral and Oropharyngeal Cancer

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 973
Author(s):  
Olivia Knittelfelder ◽  
Daniela Delago ◽  
Gabi Jakse ◽  
Sabine Reinisch ◽  
Richard Partl ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factor ◽  
Cox Regression ◽  
Cell Cancer ◽  
Survival Rates ◽  
Prognostic Significance ◽  
Independent Prognostic Factor ◽  
Operating Characteristics ◽  
Roc Curve Analysis ◽  
Cancer Specific Survival

Aminotransaminases, including aspartate aminotransaminase (AST) and alanine aminotransaminase (ALT), are strongly involved in cancer cell metabolism and have been associated with prognosis in different types of cancer. The purpose of the present study was to evaluate the prognostic significance of the pre-treatment AST/ALT ratio in a large European cohort of patients with oral and oropharyngeal squamous cell cancer (OOSCC). Data from 515 patients treated for OOSCC at a tertiary academic center from 2000–2017 were retrospectively analyzed. Levels of AST and ALT were measured prior to the start of treatment. Uni- and multivariate Cox regression analyses were applied to evaluate the prognostic value of the AST/ALT ratio for cancer-specific survival (CSS) and overall survival (OS), survival rates were calculated. Univariate analyses showed a significant association of the AST/ALT ratio with CSS (hazard ratio (HR) 1.71, 95% confidence interval (CI) 1.38–2.12; p < 0.001) and OS (HR 1.69, 95% CI 1.41–2.02; p < 0.001). In multivariate analysis, the AST/ALT ratio remained an independent prognostic factor for CSS and OS (HR 1.45, 95% CI 1.12–1.88, p = 0.005 and HR 1.42, 95% CI 1.14–1.77, p = 0.002). Applying receiver operating characteristics (ROC) curve analysis, the optimal cut-off level for the AST/ALT ratio was 1.44, respectively. In multivariate analysis, an AST/ALT ratio > 1.44 was an independent prognostic factor for poor CSS and OS (HR 1.64, 95% CI 1.10–2.43, p = 0.014 and HR 1.55, 95% CI 1.12–2.15; p = 0.008). We conclude that the AST/ALT ratio is a prognostic marker for survival in OOSCC patients and could contribute to a better risk stratification and improved oncological therapy decisions.

The Significance of Squamous Histology on Clinical Outcomes and PD-L1 Expression in Bladder Cancer

2021 ◽  
pp. 106689692110272
Author(s):  
Jennifer B. Gordetsky ◽  
Kathleen W. Montgomery ◽  
Giovanna A. Giannico ◽  
Soroush Rais-Bahrami ◽  
Prabin Thapa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Squamous Differentiation ◽  
Clinicopathologic Characteristics ◽  
Cancer Specific Survival ◽  
Kaplan Meier ◽  
Never Smokers

Objectives. To compare the clinicopathologic characteristics of urothelial carcinoma (UC), urothelial carcinoma with squamous differentiation (UCSD), and squamous cell carcinoma (SCC) of the bladder, which have been suggested to differ in terms of risk factors, immunophenotype, and prognosis. Methods. We evaluated the clinicopathologic features of radical cystectomy specimens between 1980 and 2015 with a diagnosis of SCC, UCSD, and UC. PD-L1 immunohistochemistry (clinically available clones 22C3, SP142, and SP263) was performed on SCC and UCSD. Multivariate Cox regression was used to identify prognostic factors. Kaplan–Meier curves were plotted to assess cancer-specific survival (CSS). Results. Of the 1478 cases, there were 1126 UC (76%), 217 UCSD (15%), and 135 SCC (9%). Bladder cancer was more common in men than women (80% vs 20%, P < .0001). However, a higher proportion of SCC and UCSD occurred in women (SCC-36%, UCSD-22%, UC-18%). Women were significantly more likely to be never smokers in all 3 cohorts (UC: 45% vs 16%, UCSD: 44% vs 12%, SCC: 40% vs 18%, P < .0001). Patients with SCC and UCSD were at a higher pathologic stage (>pT2) at the time of cystectomy (UCSD-74%, SCC 71%, UC-44%, P < .0001) and had worse CSS compared to patients with UC ( P = 0.006). SCC had higher PD-L1 scores (all clones) than UCSD ( P < .0001). PD-L1 22C3 ( P = .02, HR: 0.36) and SP142 scores ( P = .046, HR: 0.27) predicted CSS on Kaplan–Meier analysis for SCC cases. Conclusions. UC, UCSD, and SCC are associated with different risk factors, gender distributions, and clinical outcomes. PD-L1 is expressed in SCC and UCSD, suggesting some patients may benefit from targeted therapy.

scholarly journals Development and Validation of a Novel Risk Stratification Model for Cancer-Specific Survival in Diffuse Large B-Cell Lymphoma

2021 ◽  
Vol 10 ◽  
Author(s):  
Qiaofeng Zhong ◽  
Yuankai Shi
Keyword(s):  
Survival Rate ◽  
Risk Stratification ◽  
Predictive Accuracy ◽  
B Cell Lymphoma ◽  
Cancer Specific Survival ◽  
Web Based ◽  
Large B Cell Lymphoma ◽  
Risk Stratification Model ◽  
Ann Arbor

Diffuse large B-cell lymphoma (DLBCL) is a biologically and clinically heterogenous disease. Identifying more precise and individual survival prognostic models are still needed. This study aimed to develop a predictive nomogram and a web-based survival rate calculator that can dynamically predict the long-term cancer-specific survival (CSS) of DLBCL patients. A total of 3,573 eligible patients with DLBCL from 2004 to 2015 were extracted from the Surveillance, Epidemiology and End Results (SEER) database. The entire group was randomly divided into the training (n = 2,504) and validation (n = 1,069) cohorts. We identified six independent predictors for survival including age, sex, marital status, Ann Arbor stage, B symptom, and chemotherapy, which were used to construct the nomogram and the web-based survival rate calculator. The C-index of the nomogram was 0.709 (95% CI, 0.692–0.726) in the training cohort and 0.700 (95% CI, 0.671–0.729) in the validation cohort. The AUC values of the nomogram for predicting the 1-, 5-, and 10- year CSS rates ranged from 0.704 to 0.765 in both cohorts. All calibration curves revealed optimal consistency between predicted and actual survival. A risk stratification model generated based on the nomogram showed a favorable level of predictive accuracy compared with the IPI, R-IPI, and Ann Arbor stage in both cohorts according to the AUC values (training cohort: 0.715 vs 0.676, 0.652, and 0.648; validation cohort: 0.695 vs 0.692, 0.657, and 0.624) and K-M survival curves. In conclusion, we have established and validated a novel nomogram risk stratification model and a web-based survival rate calculator that can dynamically predict the long-term CSS in DLBCL, which revealed more discriminative and predictive accuracy than the IPI, R-IPI, and Ann Arbor stage in the rituximab era.

scholarly journals Prognostic Nomogram and Risk Stratification System for Breast Cancer Bone Metastasis: A SEER-Based Population Study

2021 ◽  
Author(s):  
Hai Lu ◽  
Jinqun Jiang ◽  
YuZhu Zhang ◽  
Rui Xu ◽  
Liping Ren ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Metastasis ◽  
Risk Stratification ◽  
External Validation ◽  
Prognostic Indicators ◽  
Tumor Subtype ◽  
Risk Stratification Model ◽  
Breast Cancer Bone Metastasis ◽  
Stratification System ◽  
Risk Stratification System

Abstract Purpose To construct and validate a nomogram and risk stratification model for predicting overall survival (OS) of patients with breast cancer bone metastasis (BCBM).Methods We collected data on BCBM patients between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were excluded if the data on the follow-up time or clinicopathological information were incomplete. The patients were randomly divided into the training set and validation set. Univariate and multivariate Cox proportional hazard regression models were performed. By integrating these variables, a predictive nomogram and risk stratification model were constructed and assessed using C-indexes and calibration curves.Results Multivariate analysis showed that age, race, marital status, tumor subtype, grade, T classification, surgery, chemotherapy, brain metastasis, liver metastasis, and lung metastasis were independent prognostic indicators of BCBM. These results were reproducible when nomograms were applied to the testing cohort for external validation. The C-index of the nomogram to predict OS was 0.704, which was higher than that of the seventh edition American Joint Committee on Cancer TNM staging system (0.564; P<0.001). A risk stratification model was further generated to accurately differentiate patients into two prognostic groups. The survival rates predicted by the nomogram showed significant distinctions between the Kaplan–Meier curves in the entire cohort and each tumor subtype. Conclusion The nomogram and risk stratification system predicting 1-, 3-, and 5-year OS for patients with newly diagnosed BCBM with satisfactory performance were constructed to help physicians in evaluating the mortality risk in patients with BCBM.

Anaemia in patients with transitional cell carcinoma (TCC) of the bladder treated with radiotherapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14569-14569
Author(s):  
C. Joynson ◽  
P. Symonds ◽  
S. Sundar
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Local Recurrence ◽  
Haemoglobin Level ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Transitional Cell ◽  
Prognostic Indicators ◽  
Significant Difference ◽  
The Impact

14569 Background: Treatment of muscle invasive TCC of the bladder with radiotherapy allows organ preservation and is frequently used in the UK especially in patients not medically fit for cystectomy. Anaemia is known to be an indicator of poor response to radiotherapy in head and neck and cervical carcinomas. This study describes the prevalence and type of anaemia in patients with TCC of the bladder and looks at the impact anaemia has on treatment outcome. Methods: Retrospective review of notes was performed on patients treated radically between 1992 and1997. Potential patient, tumour and treatment prognostic indicators were reported. Patients were labelled as being anaemic if their pre treatment haemoglobin level was below the normal range (below 13.5g/dl for men and below 11.5g/dl for women). Time to local recurrence, metastases and overall survival was recorded. Recurrence free survival and overall survival actuarial estimations were done using the Kaplan Meier method and compared by log rank testing. Multivariate analysis was carried out using Cox Regression method, correcting for potential confounding factors. Results: Data on 100 patients were available for analysis. 52 patients were anaemic with 75% of these having a normochromic, normocytic anaemia. Univariate analysis showed no significant difference in time to local recurrence, a trend to shorter time to metastases, and a significant reduction in overall survival in anaemic patients (p = 0.04). Two year survival was 43% and 22% for non anaemic and anaemic patients respectively. Multivariate analysis using covariates tumour stage, grade, and serum creatinine found anaemia to be poor prognostic indicator for overall survival (p = 0.005) and time to metastases (p = 0.003). Conclusions: Anaemia is highly prevalent in patients with bladder cancer. This retrospective study shows anaemic patients to have a worse outcome with radiotherapy treatment than patients with a normal haemoglobin level. This is not accounted for by a difference in local control which may be expected from hypoxic radiobiological principles. Anaemia may be indicative of more aggressive malignancy or sub clinical metastases. No significant financial relationships to disclose.

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