Impact of preoperative anemia on outcomes in patients undergoing curative resection for gastric cancer: a single-institution retrospective analysis of 2163 Chinese patients.

Xuechao Liu,Wei Li,Dazhi Xu,Yuying Huang,Zhiwei Zhou,Yingbo Chen,Haibo Qiu,Yuanfang Li,Xiaowei Sun

doi:10.1002/cam4.1309

Xuechao Liu, Wei Li + Show 7 more

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https://doi.org/10.1002/cam4.1309

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Journal: Cancer medicine	Publication Date: Jan 17, 2018
Citations: 36	License type: CC BY 4.0

Affiliation: Sun Yat-sen University Cancer Center

Abstract

We sought to evaluate whether preoperative anemia was an important determinant of survival in gastric cancer (GC). A single institution cohort of 2163 GC patients who underwent curative resection were retrospectively analyzed. Anemia was defined as a preoperative hemoglobin level <120 g/L in males and <110 g/L in females. Overall survival (OS) was analyzed using the Kaplan–Meier method, and a multivariate Cox proportional hazards model was performed to identify the independent prognostic factor. Anemic patients had a poorer OS compared with nonanemic patients after resection for tumor–nodes–metastasis (TNM) stage III tumors (5‐year OS rate: 32.2% vs. 45.7%, P < 0.001) but not stage I (P = 0.480) or stage II (P = 0.917) tumors. Multivariate analysis revealed that preoperative anemia was an independent prognostic factor in TNM stage III (hazard ratio [HR], 1.771; 95% CI, 1.040–3.015; P = 0.035). In a stage‐stratified analysis, preoperative anemia was still independently associated with OS in TNM stages IIIa through IIIc (P < 0.001, P = 0.075, and P = 0.012, respectively), though the association was only marginal in stage IIIb. Of note, preoperative mild anemia had a similar prognostic value in TNM stage III GC. Furthermore, preoperative anemia was significantly associated with more perioperative transfusions, postoperative complications and several nutritional‐based indices, including the prognostic nutritional index (PNI), preoperative weight loss and performance status (all P < 0.05). Preoperative anemia, even mild anemia, was an important predictor of postoperative survival for TNM stage III GC.

Highlights

Anemia is the most common hematologic abnormality of most cancers, with prevalence rates varying by cancer type and disease stage
In addition to affecting the quality of life, pretreatment anemia has been found to be a predictor of poor prognosis in many cancers [5,6,7]
The Cox proportional hazards regression models were used to further validate the results in overall patients (HR, 1.238; 95% CI, 0.995–1.539; P = 0.055), stage I patients (HR, 1.007; 95% CI, 0.232–4.383; P = 0.992), and stage II patients (HR, 0.853; 95% CI, 0.453–1.606; P = 0.623), respectively

Summary

Introduction

Anemia is the most common hematologic abnormality of most cancers, with prevalence rates varying by cancer type and disease stage. It has been assumed that between 30% and 90% of patients with cancer are anemic at diagnosis [1, 2]. Tumor-associated bleeding, abnormal catabolism of cancer patients, and nutritional deficiencies all play a role in anemic pathogenesis [3, 4]. In addition to affecting the quality of life, pretreatment anemia has been found to be a predictor of poor prognosis in many cancers [5,6,7]. One meta- analysis of 200 studies suggested that anemia was associated with reduced survival times in patients with lung carcinoma, cervicouterine carcinoma, prostatic carcinoma, head and neck carcinoma, lymphoma, and multiple myeloma [8].

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