Jian-Xian Lin1,2,3, Jun-Peng Lin1,2, Jian-Wei Xie1,2,3, Jia-Bin Wang1,2,3, Jun Lu1,2, Qi-Yue Chen1,2, Long-Long Cao1,2, Mi Lin1,2, Ruhong Tu1,2, Chao-Hui Zheng4,5,6, Chang-Ming Huang7,8,9, Ping Li10,11,12. 1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. 2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. 3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China. 4. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. wwkzch@163.com. 5. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. wwkzch@163.com. 6. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China. wwkzch@163.com. 7. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. hcmlr2002@163.com. 8. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. hcmlr2002@163.com. 9. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China. hcmlr2002@163.com. 10. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. Pingli811002@163.com. 11. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. Pingli811002@163.com. 12. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China. Pingli811002@163.com.
Abstract
BACKGROUND: Previous studies have suggested that preoperative anemia negatively influences survival in patients with gastric cancer (GC). We sought to investigate which anemic markers can better predict the prognosis of patients with resectable GC. METHODS: The study involved 2277 GC patients who underwent curative resection between December 2008 and December 2014. Cox regression models were used to identify the best anemic markers associated with prognosis. Time-dependent receiver operating characteristics analysis (t-ROC) and the estimated area under the curve (AUC) were used to compare the prognostic values. RESULTS: Of all patients, 1709 (75.1%) were male, and the median age was 61 years. Univariate analyses showed that preoperative hematocrit (HCT), hemoglobin, and mean corpuscular volume were associated with OS (all P < 0.05). However, in a separate analysis of individual stages, only HCT was shown to be significantly prognostic across all tumor stages (all P < 0.05). In the multivariate analysis, preoperative HCT remained an independent prognostic factor for GC. Low HCT was significantly associated with older age, female sex, lower body mass index, higher American Society of Anesthesiologists score, higher preoperative transfusion rate, 90-day mortality, adjuvant chemotherapy, larger tumor size, lymph node metastasis, later stage, and vascular involvement. The t-ROC curve and AUC for HCT were similar to those for the controlling nutritional status and prognostic nutritional index throughout the observation period. CONCLUSIONS: The preoperative HCT is a novel, simple, and powerful prognostic indicator of poor outcome in patients with GC and can be used as a part of the preoperative risk stratification process.
BACKGROUND: Previous studies have suggested that preoperative anemia negatively influences survival in patients with gastric cancer (GC). We sought to investigate which anemic markers can better predict the prognosis of patients with resectable GC. METHODS: The study involved 2277 GC patients who underwent curative resection between December 2008 and December 2014. Cox regression models were used to identify the best anemic markers associated with prognosis. Time-dependent receiver operating characteristics analysis (t-ROC) and the estimated area under the curve (AUC) were used to compare the prognostic values. RESULTS: Of all patients, 1709 (75.1%) were male, and the median age was 61 years. Univariate analyses showed that preoperative hematocrit (HCT), hemoglobin, and mean corpuscular volume were associated with OS (all P < 0.05). However, in a separate analysis of individual stages, only HCT was shown to be significantly prognostic across all tumor stages (all P < 0.05). In the multivariate analysis, preoperative HCT remained an independent prognostic factor for GC. Low HCT was significantly associated with older age, female sex, lower body mass index, higher American Society of Anesthesiologists score, higher preoperative transfusion rate, 90-day mortality, adjuvant chemotherapy, larger tumor size, lymph node metastasis, later stage, and vascular involvement. The t-ROC curve and AUC for HCT were similar to those for the controlling nutritional status and prognostic nutritional index throughout the observation period. CONCLUSIONS: The preoperative HCT is a novel, simple, and powerful prognostic indicator of poor outcome in patients with GC and can be used as a part of the preoperative risk stratification process.