Preoperative hemoglobin levels and iron status as predictors of prognosis in gastric cancer surgery

Purpose This study aimed to evaluate the association between clinicopathological features including prognosis, preoperative hemoglobin (Hb) levels, and iron status in patients undergoing surgery for gastric cancer. Methods A total of 634 patients scheduled for gastrectomy at Kochi Medical School between January 2014 and December 2023 were retrospectively analyzed. Clinical and biochemical data were collected to assess relationships between preoperative Hb levels, nutritional indicators, and long-term outcomes. Anemia was defined as Hb < 12.0 g/dL in women and < 13.0 g/dL in men, according to World Health Organization criteria. Results The median preoperative Hb level was 12.1 g/dL (range, 4.1–17.0 g/dL), and anemia was present in 56.2% of patients. The 5-year overall survival rate was significantly lower in patients with anemia compared to those without (62.0% vs. 78.0%; P  = 0.001). Similarly, patients who received red blood cell transfusion had a significantly lower 5-year survival rate than those who did not (44.7% vs. 73.9%; P  < 0.001). Anemic patients had significantly higher median age and C-reactive protein levels (73 years vs. 70 years; P  < 0.001, 0.16 mg/dL vs. 0.10 mg/dL; P  = 0.003), and significantly lower body mass index and serum albumin levels (20.9 vs. 22.1; P  < 0.001, 3.8 g/dL vs. 4.2 g/dL; P  < 0.001). Hb levels showed a significant positive correlation with serum albumin (r = 0.555, P  = 0.035). Conclusions Preoperative anemia was observed in over half of gastric cancer patients and was significantly associated with poorer nutritional status, systemic inflammation, and reduced long-term survival.