Impact of haemoglobin level and blood transfusion on survival outcome of gastric cancer patients – A single institute experience.


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Shahid Gilani, Naima Ikram, Arshad Jamil

Abstract

Background

Anaemia is common complication in many solid tumours, frequently occurring in gastric cancer. About 41% patients with advanced gastric cancer had haemoglobin (Hb) less than 100g/L. Causes are multi-factorial. Studies have shown it as an independent factor in survival outcome in various cancers, but few have focussed on gastric cancer. RBC transfusion is frequently advised but it is less clear whether it has survival benefit. We aimed to determine initial and nadir Hb in gastric cancer patients, and to identify its impact on their overall survival (OS).

Method

A retrospective study for 112 patients from 2013 to 2020 at University hospital of North Midlands, UK. Patients demographics and clinical data was analysed for survival outcome in relation to various factors including level of Hb. Univariate, multivariate and Kaplan-Meier survival analysis were done.

Results

112 patients, median age 73 years, among them, 79 males (70%), most of them had stage-III and stage-IV disease. Total of 88 out of 112 patients (78%) did not get surgery due to inoperable cancers. Vast majority of patients (85%) received RBC transfusions to improve anaemia. Majority of patients received EOX or ECX chemotherapy (93%). Survival: Of 112 patients 98 (87.5%) died. The estimated median OS was 12 months (SD=17). The 1, 3, and 5 years OS were 55%, 30% and 10% respectively. The median progression free survival (PFS) with any treatment was 18 months (SD=20). The patients with higher Hb (>100 g/L) did better than with lower Hb (<80 g/L). Univariate analysis showed statistical significance of level of Hb and resection method to OS (P=0.0122 and P=0.0001). Multivariate analysis did show stage, surgical resection and Hb level as independent factors to the outcome.   

Conclusion

The point prevalence of anaemia in our gastric cancer patients during treatment had an effect on overall survival. The outcome couldn't be improved with RBC transfusion. Our findings indicate the need for consistent diagnostic and treatment approach to anaemia in this setting.  

Impact statement

Low Hb level in gastric cancer is associated with poor outcome, irrespective of blood transfusion, may hint under lying immune mechanism  calling for future research aiming at immune system response towards growing cancer.