The Prognostic Significance of Preoperative Anemia in Gastric Cancer Patients

Abstract

Background/aim: This study aimed to investigate the prognostic significance of preoperative anemia in gastric cancer patients.

Patients and methods: The medical records of 801 patients with gastric cancer who underwent gastrectomy at the Nara Medical University hospital, were reviewed. Anemia was defined as a hemoglobin (Hb) level of <10 g/dl. Multivariate analysis was performed to identify prognostic factors.

Results: The mean Hb level was 13.1 (SD=2.0). Sixty-four (8.0%) patients were classified into the anemic group. Anemic patients were significantly older than nonanemic patients (p=0.007). Anemia was significantly associated with cardiovascular disease (p=0.041), chronic renal failure (p<0.001), tumor depth (p<0.001), and lymph node metastasis (p=0.001). The overall survival (OS) and cause-specific survival (CSS) rates of anemic patients were significantly lower in comparison to the nonanemic patients (p<0.001). In a subgroup analysis, the OS rate of anemic patients was significantly lower than that of nonanemic patients among patients with stage I and stage II disease. According to a multivariate analysis, preoperative anemia was an independent prognostic factor for OS (p<0.001), but not CSS (p=0.555). The rate of non-cancer deaths among anemic patients was significantly higher than that among nonanemic patients (p<0.001).

Conclusion: Preoperative anemia is a simple and reliable predictor of poor prognosis, and it is associated with a higher risk of non-cancer death.

Keywords: Anemia; cause of death; gastric cancer; prognosis.