The purpose of this study was to evaluate whether tumour response to primary chemotherapy in human breast cancer is influenced
by baseline haemoglobin (Hb) status. A total of 157 patients with T2-4, N0-1 M0 breast cancer were treated with chemotherapy
consisting of either the CMF regimen þ tamoxifen (the first 76 cases) or the single-agent epirubicin (the subsequent 81) before
definitive surgery. In total, 144 patients were fully assessable. Ki67, p53, bcl-2, c-erbB2, steroid hormone receptor, and microvessel
density were evaluated immunohistochemically in tumour specimens obtained before chemotherapy and at surgery. Tumour
shrinkage 450% occurred in 72.1% of patients. Responding patients had higher baseline Hb levels and red blood cell counts than
nonresponders (Po0.01 and o0.003, respectively). The distribution of disease response according to increasing cutoffs of baseline
Hb status showed that from 12.5 mg l1 onwards, patients with Hb levels above the cutoff obtained a greater response rate than
those with lower Hb values. The difference attained the statistical significance at 12.5 (76.1 vs 59.5%, Po0.05) and 13.0 g/dl1 (81.0 vs
57.6%, Po0.002) cutoffs, respectively. The predictive role of Hb levels was maintained in multivariate analysis after adjustment for
clinical and biological characteristics and treatment regimen. Patients with baseline Hb levels p13 g dl1 showed a lower treatmentinduced
reduction in Ki67 expression (Po0.04) and a higher Ki67 expression at postoperative evaluation (Po0.02) than their
counterparts. In conclusion, low Hb levels may negatively influence the response rate of chemotherapy in breast cancer patients.
Inhibition of antiproliferative activity could be a possible mechanism.
