Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Int J Clin Oncol. 2018 Aug;23(4):671-680. doi: 10.1007/s10147-018-1274-7. Epub 2018 Apr 9.
Patients with gastric cancer (GC) are affected by changes in iron status. Before surgery, GC patients are likely to have iron-deficiency anemia; and after gastrectomy, patients suffer from low nutritional status and low iron. This study investigated preoperative iron status associated with prognosis after curative gastrectomy for gastric cancer.
We evaluated preoperative serum hemoglobin (Hgb), Fe and total iron-binding capacity (TIBC) in 298 patients who underwent curative gastrectomy for GC without preoperative chemotherapy, and analyzed these factors' associations with prognosis after surgery.
Of the 298 patients, 129 (43.2%) had low Hgb levels, and 33 (11.1%) had low TIBC (< 260 µg/dl) that was not associated with Hgb or Fe level. Patients with low TIBC were significantly associated with older age (≥ 65 years old; P = 0.0085), low albumin (< 3.9 g/dl; P = 0.0388) and high CRP (≥ 0.15 mg/dl; P = 0.0018) in multivariate analysis. Low Fe (< 60 µg/dl) was not associated with disease-free survival (DFS) or overall survival (OS); however, low Fe was associated with longer cancer-specific survival in Stage III GC patients (P = 0.0333). Both low Hgb and low TIBC were significantly associated with shorter DFS (Hgb: P = 0.0433; TIBC: P < 0.0001) and shorter OS (Hgb: P = 0.0352; TIBC: P < 0.0001). Low TIBC were significantly associated with shorter DFS (HR 2.167, 95% CI 1.231-3.639, P = 0.0086) and shorter OS (HR 2.065, 95% CI 1.144-3.570, P = 0.0173) in multivariate Cox hazard regression analysis.
Preoperative serum TIBC level of GC patients who undergo curative gastrectomy is a novel prognostic marker in univariate and multivariate analyses.
胃癌（GC）患者的铁状态会发生变化。在手术前，GC 患者可能患有缺铁性贫血；在胃切除术后，患者会出现营养状况不佳和缺铁的情况。本研究调查了与 GC 患者根治性胃切除术后预后相关的术前铁状态。
我们评估了 298 例未经术前化疗而行根治性胃切除术的 GC 患者的术前血清血红蛋白（Hgb）、Fe 和总铁结合能力（TIBC），并分析了这些因素与术后预后的关系。
在 298 例患者中，有 129 例（43.2%）存在低 Hgb 水平，33 例（11.1%）存在低 TIBC（<260μg/dl），但与 Hgb 或 Fe 水平无关。多变量分析显示，TIBC 低的患者与年龄较大（≥65 岁；P=0.0085）、白蛋白较低（<3.9g/dl；P=0.0388）和 CRP 较高（≥0.15mg/dl；P=0.0018）显著相关。低 Fe（<60μg/dl）与无病生存率（DFS）或总生存率（OS）无关；然而，低 Fe 与 III 期 GC 患者的更长癌症特异性生存率相关（P=0.0333）。低 Hgb 和低 TIBC 均与较短的 DFS（Hgb：P=0.0433；TIBC：P<0.0001）和较短的 OS（Hgb：P=0.0352；TIBC：P<0.0001）显著相关。多变量 Cox 风险回归分析显示，低 TIBC 与较短的 DFS（HR 2.167，95%CI 1.231-3.639，P=0.0086）和较短的 OS（HR 2.065，95%CI 1.144-3.570，P=0.0173）显著相关。
接受根治性胃切除术的 GC 患者术前血清 TIBC 水平是单变量和多变量分析中的一个新的预后标志物。
