| Purpose: The purpose of this study was to explore the relationship between preoperative hemoglobin concentration and postoperative survival,understand the correlation between preoperative hemoglobin concentration and other clinical and pathological characteristics,and evaluate the prognostic significance of preoperative hemoglobin index for postoperative long-term survival of early gastric cancer by analyzing the difference of preoperative human hemoglobin concentration in postoperative survival curve of patients with early gastric cancer.To provide a new clinical reference index for the selection of treatment methods for early gastric cancer and the formulation of postoperative diagnosis and treatment plans,optimize the diagnosis and treatment contents and treatment plans for early gastric cancer,so as to reduce the probability of postoperative recurrence and metastasis in patients with early gastric cancer and improve the long-term survival time of patients with early gastric cancer.Methods: This study reviewed and analyzed 1451 patients with early gastric cancer who received radical gastrectomy accompanied by lymph node dissection in the First Affiliated Hospital of Anhui Medical University from June 2011 to January 2020.The clinical data and postoperative clinicopathological data of patients from admission to discharge were collected.Firstly,patients with early gastric cancer were divided into anemia group and non-anemia group,and Pearson Chi-square test or Fisher’s exact probability method was used to evaluate the baseline consistency of clinical and pathological data in the two groups.Patients with early gastric cancer were then divided into a lymph node metastasis group and a group without lymph node metastasis,and the baseline consistency of clinical and pathological data in the two groups was evaluated using the same method as above.Backward stepwise COX regression was used for univariate and multivariate analyses of the two grouping schemes,and some of the relevant variables were corrected in the multivariate COX proportional risk model.COX proportional risk model was used to draw Kaplan-Meier survival curves,and the differences of intra-group survival curves between the two grouping schemes were compared.The effects of preoperative hemoglobin indexes and lymph node metastasis on postoperative long-term survival were evaluated respectively,and the significance of preoperative hemoglobin on postoperative long-term survival was understood based on this.Results:1.A total of 1451 patients with early gastric cancer who underwent radical gastrectomy were included in this study,among which the incidence of anemia was 33.01%(479/1451);2.Old age,hypoproteinemia,submucosal infiltration,and tumor with general type of uplift were related to anemia;3.Multivariate analysis showed that anemia(HR = 0.436;P = 0.000),lymph node metastasis(HR = 0.451;P = 0.000),total or proximal gastrectomy(HR = 1.794 and 2.322;P = 0.004 and 0.007)and neuroaggression(HR = 0.457;P = 0.022)was an independent risk factor for death;4.The 5-year and 10-year overall survival rates of early gastric cancer patients with anemia were 90.1% and 73.7%,respectively,significantly lower than those of patients without anemia(95.4% and 88.3%,P = 0.000).5-year and 10-year overall survival rates were 86.2% and 80.5%,respectively,in patients with positive lymph node metastases,significantly lower than those in patients with negative lymph node metastases(94.8%and 83.7%,P = 0.011);5.The 5-year overall survival rates were 95.4%,93.1%,86.5% and 79.5%,respectively,and the 10-year overall survival rates were 88.3%,77.4%,67.9% and 63.6%,respectively,in the anemia free group and the mild,moderate and severe anemia group.The overall survival rate was significantly different among the four groups(P = 0.000).Compared with the non-anemic group,there were statistically significant differences in the survival curves of the mild,moderate and severe anemia groups(P = 0.031,P < 0.001 and P <0.001,respectively);6.5-year overall survival rates were 94.8%,90.8%,81.2% and 74.0% in the N0,N1,N2 and N3 groups,and 10-year overall survival rates were 83.8%,82.8%,77.5% and 74.0%,respectively.There were statistically significant differences in overall survival among the four groups(P < 0.001).However,in the overall survival curve,only the N0 group had a statistically significant difference compared with N2 or N3(P = 0.002 and 0.004),and no statistically significant difference was found in other pairwise comparisons;Conclusions:1.Anemia and lymph node metastasis were both independent prognostic factors in multivariate analysis,and remained independent prognostic factors after correction for related factors;2.Patients with anemia or positive lymph node metastasis were more likely to have poor prognosis,and patients with anemia and lymph node metastasis had the worst prognosis;3.The prognosis of patients with anemia only was similar to that of patients with lymph node metastasis only.4.The patient’s poor prognosis was proportional to the severity of anemia,and the progressive survival curve was more dispersed than the progressive lymph node curve.This indicated that the grading value of anemia was higher than that of lymph nodes.5.Compared with T stage,anemia plays a greater role in postoperative outcome of early gastric cancer;6.The same conclusion can also be drawn from the survival curve of the Chinese standard anemia classification,which is the same as the WHO anemia classification above;7.Whether the correction of preoperative anemia can reduce the recurrence rate and mortality remains to be investigated;... |
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