Anemia significantly affects quality of life of cancer patients, but the impact of hemoglobin levels on survival is still unclear. The aim of this retrospective study was to assess the prognostic role of pre-chemotherapy hemoglobin levels in patients with ovarian cancer. Two hundred twenty-two patients were divided in 3 groups based on baseline hemoglobin levels (< 10 gr/dl (54 pts., 24%); 10-11.9 gr/dl (87 pts., 39%), > or = 12 gr/dl (82 pts., 37%)). Correlations among baseline characteristics (age, ECOG performance status, stage, grading, histology, residual disease after primary surgery) and baseline hemoglobin level were analyzed. Poor performance status (p = 0.03), more advanced stage (p = 0.01), and sub-optimal residual disease (p = 0.002) were more frequent in patients with lower hemoglobin values. There was no significant correlation between baseline hemoglobin level and response rate to subsequent chemotherapy. Based on univariate analysis, hemoglobin categories were statistically significant predictors for time to progression (p = 0.0002) and overall survival (p < 0.0001). Based on multivariate analysis, patients with hemoglobin between 10 and 12 g/dl had a 1.45 hazard ratio (HR) for recurrence and a 1.35 HR of death compared with patients with normal hemoglobin. Patients with hemoglobin < 10 g/dl had a 2.02 HR of recurrence and a 2.49 HR of death compared with patients with normal hemoglobin. These findings show that hemoglobin level prior to chemotherapy is an independent predictor of progression-free survival and overall survival in patients treated for ovarian carcinoma.