Tsutomu Namikawa, Kento Shinno, Masahiro Maeda, Masato Utsunomiya, Keiichiro Yokota, Kazune Fujisawa, Masaya Munekage, Hiromichi Maeda, Hiroyuki Kitagawa, Yoko Ishioka, Yumi Okinaka, Kyoko Osaka, Satoru Seo
Preoperative anemia is highly prevalent and significantly associated with poor long-term survival, particularly in stage I/II gastric cancer. As a modifiable risk factor reflecting physiological reserve, preoperative optimization of the hemoglobin level may improve outcomes in this population.
BACKGROUND/AIM: This study aimed to evaluate the association between clinicopathological features, iron status, and prognosis in patients undergoing gastrectomy for gastric cancer.
PATIENTS AND METHODS: We retrospectively analyzed 634 patients who underwent gastrectomy between 2014 and 2023. Anemia was defined by World Health Organization criteria (Hb <12.0 g/dl in women, <13.0 g/dl in men). Survival outcomes were assessed using Kaplan-Meier and Cox proportional hazards models.
RESULTS: Preoperative anemia was present in 61.8% of patients. The 5-year overall survival rate was significantly lower in patients with anemia (62.0% vs. 78.0%; p=0.001) and those receiving blood transfusion (44.7% vs. 73.9%; p<0.001). Multivariate analysis identified stage, age, and comorbidities as independent prognostic factors. Although anemia was not an independent factor considering the entire cohort, stage-stratified analysis revealed that in patients with stage I/II disease, the 5-year overall survival rate was significantly lower in the group with anemia (83.0% vs. 93.8%; p=0.024). Hemoglobin levels were significantly positively correlated with serum iron (r=0.554) and albumin (r=0.555) levels.
CONCLUSION: Preoperative anemia is highly prevalent and significantly associated with poor long-term survival, particularly in stage I/II gastric cancer. As a modifiable risk factor reflecting physiological reserve, preoperative optimization of the hemoglobin level may improve outcomes in this population.