Worse oncological impact of preoperative anemia in patients with locally advanced gastric cancer after curative gastrectomy: A retrospective cohort study

Abstract

Background

The impact of preoperative anemia on long-term survival outcomes after gastrectomy remains unclear. This study determined the effect of preoperative anemia on long-term survival outcomes in patients undergoing gastrectomy for gastric cancer.

Methods

This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary pStages I–III gastric cancer between May 2006 and March 2017. According to the World Health Organization hemoglobin classification, ≥13.0 g/dL for men and ≥12.0 g/dL for women are considered normal, 11.0–12.9 g/dL for men and 11.0–11.9 g/dL for women as mild anemia, 8.0–10.9 g/dL moderate anemia, and <8.0 g/dL as severe anemia. The primary outcome was overall survival (OS). Comparisons were made using the log-rank test, and prognostic factors were identified using Cox proportional hazards regression analysis.

Results

The median follow-up duration was 60 months. Of 4730 patients, 3066 (64.8 %) were classified as normal, 1093 (23.1 %) as mild, 540 (11.4 %) as moderate, and 31 (0.7 %) as severe anemia. Patients with anemia had poorer survival outcomes than those without anemia (P < 0.001). No differences were found among survival outcomes in OS based on severity. When stratified by pStage, patients with anemia had a poorer survival outcome than those without anemia in each pStage. Multivariate analysis showed that preoperative anemia was an independent poor prognostic factor for OS regardless of blood transfusion (hazard ratios: 1.650, 95 % confidence interval: 1.432–1.902, P < 0.001).

Conclusions

Preoperative anemia, independent of perioperative blood transfusions, may worsen OS in patients with gastric cancer after curative gastrectomy.