Prognostic Value of Baseline and Post-Treatment Hemoglobin Levels in Head and Neck Squamous Cell Carcinoma: Insights from a Multi-Center Cohort Study

Abstract

Background: Hemoglobin (Hb) is a readily available biomarker that has the potential to affect the outcome in the squamous cell carcinoma of the head and neck by altering the level of tumor hypoxia and treatment response. Its prognostic value in prolonged survivors is to be clarified.

Methods: A multicenter cohort study across five tertiary centers in Kanpur, India, enrolled 250 patients with newly diagnosed HNSCC treated with definitive radiotherapy or chemoradiotherapy (2008–2022). Hb was measured to determine the baseline and 12 months. Kaplan-Meier analysis was used to assess the survival outcomes and the overall survival (OS) was assessed and related to Hb and also multivariate Cox analysis assessed the relationships between Hb results and survival outcomes after correcting and adjusting the results according to age, sex, tumor location, stage, performance status, and treatment modality.

Results: The average age was 52 years (mean 50.8), with 60% males. Squamous cell carcinoma involved 70% of cases. Treatment included radiotherapy alone (40%), chemotherapy alone (15.2%), and chemoradiotherapy (44.8%). Mean Hb increased from 12.8 ± 1.5 g/dL at baseline to 13.5 ± 1.2 g/dL at one year (+0.7 g/dL; 95% CI: 0.55–0.85). Baseline anemia (Hb <13 g/dL) was present in 48%. One-year OS was significantly lower in anemic versus non-anemic patients (62% vs. 78%, p<0.01). In adjusted models, anemia remained independently connected with poorer OS (HR 2.05; 95% CI: 1.34–3.15; p=0.001). The progression-free and survival of the cancer, when measured over a period of one year, stood at 85% and 90, respectively.

Conclusions: Baseline hemoglobin and one-year recovery serve as independent prognostic indicators in HNSCC. Prospective studies are needed for validation