Ferric carboxymaltose reduces transfusions and hospital stay in patients with colon cancer and anemia

José Luis Calleja, Salvadora Delgado, Adolfo del Val, Antonio Hervás, José Luis Larraona, Álvaro Terán, Mercedes Cucala, Fermín Mearin, Colon Cancer Study Group, Jesús-Alberto Varela, Teresa Broquetas, Francisco-Javier Esteban, Luis Ferrer, Laura Sanchis, Federico Argüelles, Montserrat Andreu, José Luis Calleja, Salvadora Delgado, Adolfo del Val, Antonio Hervás, José Luis Larraona, Álvaro Terán, Mercedes Cucala, Fermín Mearin, Colon Cancer Study Group, Jesús-Alberto Varela, Teresa Broquetas, Francisco-Javier Esteban, Luis Ferrer, Laura Sanchis, Federico Argüelles, Montserrat Andreu

Abstract

Purpose: The purpose of the study was to evaluate the efficacy of preoperative intravenous (IV) ferric carboxymaltose (FCM) administration vs. no-IV iron in colon cancer (CC) anemic patients undergoing elective surgery with curative intention.

Methods: This was a multicenter, observational study including two cohorts of consecutive CC anemic patients: the no-IV iron treatment group was obtained retrospectively while FCM-treated patients were recorded prospectively.

Results: A total of 266 patients were included: 111 received FCM (median dose 1000 mg) and 155 were no-IV iron subjects. Both groups were similar in terms of demographic characteristics, tumor location, surgical approach, and intra-operative bleeding severity. The FCM group showed a significant lower need for red blood cell (RBC) transfusion during the study (9.9 vs. 38.7%; OR: 5.9, p < 0.001). In spite of lower hemoglobin levels at baseline diagnosis and lower transfusion rates in the FCM group, the proportion of responders was significantly higher with respect to the no-IV group both at hospital admission (48.1 vs. 20.0%, p < 0.0001) and at 30 days post-surgery (80.0 vs. 48.9%, p < 0.0001). The percentage of patients with normalized hemoglobin levels was also higher in the FCM group (40.0 vs. 26.7% at 30 days, p < 0.05). A lower number of reinterventions and post-surgery complications were seen in the FCM group (20.7 vs. 26.5%; p = 0.311). The FCM group presented a significant shorter hospital stay (8.4 ± 6.8 vs. 10.9 ± 12.4 days to discharge; p < 0.001).

Conclusions: Preoperative ferric carboxymaltose treatment in patients with CC and iron deficiency anemia significantly reduced RBC transfusion requirements and hospital length of stay, reaching higher response rates and percentages of normalized hemoglobin levels both at hospital admission and 30 days post-surgery.

Keywords: Colon cancer surgery; Ferric carboxymaltose; Iron deficiency anemia; Iron intravenous administration.

Figures

Fig. 1
Fig. 1
Evolution of hemoglobin levels (g/dL) at four time points: diagnosis, hospital admission, discharge, and 30 days post-surgery. Groups were not censored for transfusions. Significant differences between groups are marked with an asterisk for Hb and dagger for serum ferritin (*p < 0.05; **/†p < 0.005; ***/‡p < 0.001). Ferric carboxymaltose (FCM) was administered during diagnosis period
Fig. 2
Fig. 2
Percentage of hemoglobin responders—defined as those with an Hb increase of ≥1.5 g/dL—at hospital admission and 30 days post-surgery with respect to Hb diagnosis levels. Data was not censored for transfusions
Fig. 3
Fig. 3
Mean length of hospital stay measured from the day of surgery until the hospital discharge

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Source: PubMed

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