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Preoperative Hematocrit (HCT) is a Novel and Simple Predictive Marker for Gastric Cancer Patients Who Underwent Radical Gastrectomy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgment

Scientific and technological innovation joint capital projects of Fujian Province, China (No. 2016Y9031). Minimally invasive medical center of Fujian Province (No. [2017]171). Project supported by the Science Foundation of the Fujian Province, China (Grant No. 2018J01307). Startup Fund for scientific research, Fujian Medical University (No. 2016QH024).

Author information

Author notes

  1. Jian-**an Lin and Jun-Peng Lin have contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Jian-**an Lin PhD, Jun-Peng Lin MD, Jian-Wei **e PhD, Jia-bin Wang PhD, Jun Lu PhD, Qi-Yue Chen MD, Long-long Cao MD, Mi Lin MD, Ruhong Tu MD, Chao-Hui Zheng PhD, Chang-Ming Huang MD & ** Li PhD

  2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Jian-**an Lin PhD, Jun-Peng Lin MD, Jian-Wei **e PhD, Jia-bin Wang PhD, Jun Lu PhD, Qi-Yue Chen MD, Long-long Cao MD, Mi Lin MD, Ruhong Tu MD, Chao-Hui Zheng PhD, Chang-Ming Huang MD & ** Li PhD

  3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China

    Jian-**an Lin PhD, Jian-Wei **e PhD, Jia-bin Wang PhD, Chao-Hui Zheng PhD, Chang-Ming Huang MD & ** Li PhD

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Contributions

Lin JX, Lin JP, Zheng CH, Huang CM, and Li P conceived of the study, analyzed the data, and drafted the manuscript. Tu RH, Li P, **e JW, Wang JB, and Li P helped revise the manuscript critically for important intellectual content; Lu J, Chen QY, Cao LL, and Lin M helped collect data and design the study.

Corresponding authors

Correspondence to Chao-Hui Zheng PhD, Chang-Ming Huang MD or ** Li PhD.

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Conflict of interest

There are no conflicts of interest or financial ties to disclose from any of author.

Human rights statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent or substitute for it was obtained from all patients for being included in the study.

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Supplementary material 1 (DOC 107 kb)

Supplemental Fig.

 1 Flow chart of the analyzed patients (TIFF 53 kb)

Supplemental Fig.

 2 Relationship between OS and Hb in all stages (A) and in stage I (B), stage II (C), and stage III (D) GC patients (TIFF 160 kb)

Supplemental Fig.

 3 Relationship between OS and MCV in all stages (A) and in stage I (B), stage II (C), and stage III (D) GC patients (TIFF 184 kb)

Supplemental Fig.

 4 Associations of the COUNT (A) and PNI (B) with HCT (TIFF 77 kb)

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Lin, JX., Lin, JP., **e, JW. et al. Preoperative Hematocrit (HCT) is a Novel and Simple Predictive Marker for Gastric Cancer Patients Who Underwent Radical Gastrectomy. Ann Surg Oncol 26, 4027–4036 (2019). https://doi.org/10.1245/s10434-019-07582-7

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  • DOI: https://doi.org/10.1245/s10434-019-07582-7

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