Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Ann Surg Oncol. 2019 Nov;26(12):4027-4036. doi: 10.1245/s10434-019-07582-7. Epub 2019 Aug 28.
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.
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.
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.
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.
先前的研究表明，术前贫血会对胃癌（GC）患者的生存产生负面影响。我们试图研究哪些贫血标志物可以更好地预测可切除 GC 患者的预后。
这项研究纳入了 2277 名在 2008 年 12 月至 2014 年 12 月期间接受根治性切除术的 GC 患者。使用 Cox 回归模型来确定与预后相关的最佳贫血标志物。时间依赖性接收者操作特征分析（t-ROC）和估计曲线下面积（AUC）用于比较预后价值。
在所有患者中，1709 名（75.1%）为男性，中位年龄为 61 岁。单因素分析显示，术前血细胞比容（HCT）、血红蛋白和平均红细胞体积与 OS 相关（均 P<0.05）。然而，在对各个分期的单独分析中，仅 HCT 在所有肿瘤分期中均显示出显著的预后（均 P<0.05）。在多因素分析中，术前 HCT 仍然是 GC 的独立预后因素。低 HCT 与年龄较大、女性、较低的体重指数、较高的美国麻醉医师协会评分、较高的术前输血率、90 天死亡率、辅助化疗、肿瘤较大、淋巴结转移、较晚的分期和血管受累显著相关。在整个观察期间，HCT 的 t-ROC 曲线和 AUC 与控制营养状况和预后营养指数相似。
术前 HCT 是 GC 患者预后不良的一种新的、简单且强大的预后指标，可以作为术前风险分层过程的一部分。
