Kim Eun Young, Song Kyo Young, Kim Dong Jin
Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Front Oncol. 2025 Mar 14;15:1487477. doi: 10.3389/fonc.2025.1487477. eCollection 2025.
This study identified the trends and clinical significance of anemia and ferritin status 1 year postoperatively in patients with long-term survival and analyzed clinicopathological factors and preoperative nutritional/inflammatory conditions associated with anemia of chronic disease (ACD) development.
Between March 2009 and December 2018, 2,976 patients who underwent curative gastrectomy for gastric cancer without recurrence or mortality within postoperative 1 year were included. The patients were categorized into four groups; non-iron deficiency without anemia, iron deficiency without anemia, iron deficiency anemia (IDA), and ACD based on postoperative 1 year ferritin and hemoglobin.
The overall incidence of anemia was 36.5% (n=1,086). The prevalence of IDA and ACD was 12.7% (n=377) and 23.8 (n=709), respectively, at postoperative 1 year. Patients with ACD were significantly older, had higher ECOG, increased early complications, and were at a more advanced stage than the other groups. The overall survival (OS) of ACD was significantly lower than that of the other groups ( < 0.001), especially for stages I and III. The presence of ACD was a significant risk factor for overall (hazard ratio [HR] = 1.832, < 0.001), disease-free (HR= 1.714, = 0.003), and cancer-specific (HR= 1.690, = 0.015) survival. Older age, advanced disease stage, low preoperative prognostic nutritional index, preoperative anemia, and early postoperative complications were significant risk factors for ACD.
Relationship between ferritin and Hb at postoperative 1 year is a significant prognostic factor for survival in patients with gastric cancer. Particularly, ACD may be a specific predictor of gastric cancer. Therefore, clinicians need to pay attention to ACD status and prevent the risk factors for its development during long-term postoperative follow-up.
本研究确定了长期存活患者术后1年贫血和铁蛋白状态的趋势及临床意义，并分析了与慢性病贫血（ACD）发生相关的临床病理因素及术前营养/炎症状况。
纳入2009年3月至2018年12月期间接受胃癌根治性胃切除术且术后1年内无复发或死亡的2976例患者。根据术后1年的铁蛋白和血红蛋白水平，将患者分为四组：非缺铁性无贫血、缺铁性无贫血、缺铁性贫血（IDA）和ACD。
贫血的总体发生率为36.5%（n = 1086）。术后1年时，IDA和ACD的患病率分别为12.7%（n = 377）和23.8%（n = 709）。与其他组相比，ACD患者年龄显著更大，东部肿瘤协作组（ECOG）评分更高，早期并发症更多，且分期更晚。ACD患者的总生存期（OS）显著低于其他组（<0.001），尤其是I期和III期。ACD的存在是总体生存（风险比[HR]=1.832，<0.001）、无病生存（HR = 1.714，=0.003）和癌症特异性生存（HR = 1.690，=0.015）的显著危险因素。年龄较大、疾病分期较晚、术前预后营养指数较低、术前贫血和术后早期并发症是ACD的显著危险因素。
术后1年铁蛋白与血红蛋白之间的关系是胃癌患者生存的重要预后因素。特别是，ACD可能是胃癌的一个特异性预测指标。因此，临床医生在长期术后随访期间需要关注ACD状态并预防其发生的危险因素。
