Anemia syndrome associated with malignant neoplasms in patients with colorectal cancer

Abstract

Background. Colorectal cancer is the most commonly diagnosed cancer among all malignant neoplasms. This disease is accompanied by the development of anemic syndrome (AS). This complication not only worsens the results of treatment and, as a result, reduces overall survival, but also reduces the quality of life of patients, reduces adherence to treatment.Aim. To study the expression of hepcidin 25 (HP25), prohepcidin (PROHP), ferritin (FR), interleukin 6 (IL-6) and metabolites of nitric oxide (NOx) in the peripheral blood of patients colorectal cancer, to assess their relationship with the clinical course of the disease and with AS.Materials and methods. The study was conducted in 41 patients with colorectal cancer and AS. The content of FR, PROHP, HP25, IL-6 was determined using enzyme immunoassay. The total content of NOx in blood serum was determined using the Griess reagent after the reduction of nitrate to nitrite with cadmium granules in the presence of zinc.Results. There are three types of AS. A characteristic feature of which was microcytosis (MCV – 74.3 ± 2.1 fl) and hypochromia (MHC – 22.9 ± 1.2 pg) of erythrocytes. Type 1 of AS – iron deficiency anemia (IDA), type 2 – anemia of chronic diseases (ACD) in combination with iron deficiency erythropoiesis and type 3 – ACD with functional iron deficiency (FID). True IDA was detected in 15 (36.6 %) patients, which was classically characterized by: low concentration of FR, PROGP, GP25, IL-6 and NOx. A less significant group (9 patients, 21.9 %) had a high concentration of FR and low PROHP, GP25, IL-6, NOx, which indicated iron deficiency against the background of ACD. It differed from the first group with IDA in a significant concentration of FR, which may indicate the transition of IDA to the chronic phase of AS. Third group (17 patients, 41.5 %) – with FID – turned out to be the most numerous and characterized by a high concentration of FR (386.7 ± 41.2 ng/ml), GP25 (43.2 ± 7.1 ng/ml), PROHP (283.3 ± 18.5 ng/ml), IL-6 (24.8 ± 5.5 pg/ml), NOx (39.7 ± 5.5 µmol/l), the values were significantly higher (p <0.001) than in patients with IDA and ACD with iron deficiency erythropoiesis.Conclusion. In patients with a widespread tumor process, AS with FID is most often detected. FID was accompanied by hyperproduction of FR, IL-6, GP25, PROGP and NOx. A close correlation was noted between the studied parameters with an increase in the T-stage of colorectal cancer. This may indicate the relationship of these proteins in the development of cytokine-induced anemia in cancer patients. The data obtained can be widely used to assess the state of metabolic disorders in anemia associated with malignant neoplasms for the differential diagnosis of AS variants and adequate treatment.