Open AccessPreoperative transferrin level is a novel prognostic marker for colorectal cancer
Author(s) -
Sawayama Hiroshi,
Miyamoto Yuji,
Hiyoshi Yukiharu,
Shimokawa Mototsugu,
Kato Rikako,
Akiyama Takahiko,
Sakamoto Yuki,
Daitoku Nobuya,
Yoshida Naoya,
Baba Hideo
Publication year - 2021
Publication title -
annals of gastroenterological surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.308
H-Index - 15
ISSN - 2475-0328
DOI - 10.1002/ags3.12411
Subject(s) - transferrin , medicine , hazard ratio , gastroenterology , proportional hazards model , univariate analysis , colorectal cancer , albumin , confidence interval , multivariate analysis , cancer
Abstract Aim This study investigated whether preoperative serum transferrin, a rapid‐turnover protein, was associated with prognosis after colorectal cancer (CRC) resection. Methods We evaluated preoperative transferrin, which was calculated as iron and unsaturated iron‐binding capacity, in 501 patients who underwent surgery for Stage I–III CRC. Transferrin level was directly proportional to total iron‐binding capacity (TIBC), and TIBC < 250 μg/dl was defined as low transferrin. The associations between transferrin and prognosis were evaluated in univariate and multivariate Cox proportional hazards analyses. Results Fifty‐eight of 501 patients (11.5%) had low transferrin. In these patients, low transferrin was significantly associated with high age, female gender, low body mass index (<18.5), high white blood cell count, low total protein, low albumin, high C‐reactive protein, low hemoglobin, and low neutrophil/lymphocyte ratio. In the univariate analysis, low transferrin was associated with shorter relapse‐free survival (RFS) (hazard ratio [HR] 2.180, 95% confidence interval [CI] 1.417‐3.354, P < .001), overall survival (OS) (HR 2.930, 95% CI 1.784‐4.811, P < .001), and cancer‐specific survival (CSS) (HR 2.122, 95% CI 1.053‐4.275, P = .035). In multivariate analysis, high age ( P < .001), Glasgow Prognostic Score ( P = .009), and low transferrin (HR 2.336, 95% CI 1.173‐4.654, P = .011) were independently associated with shorter OS, and depth of invasion pT4 ( P = .015), presence of lymph node metastasis ( P = .001), low hemoglobin ( P = .034), and low transferrin (HR 2.638, 95% CI 1.113‐5.043, P = .025) were independently associated with shorter CSS. Conclusions Preoperative serum transferrin in Stage I–III CRC patients was identified as a novel prognostic marker by univariate and multivariate analyses.