Impact of preoperative anemia on outcomes in patients undergoing curative resection for gastric cancer: a single‐institution retrospective analysis of 2163 Chinese patients

We sought to evaluate whether preoperative anemia was an important determinant of survival in gastric cancer ( GC ). A single institution cohort of 2163 GC patients who underwent curative resection were retrospectively analyzed. Anemia was defined as a preoperative hemoglobin level <120 g/L in males and <110 g/L in females. Overall survival ( OS ) was analyzed using the Kaplan–Meier method, and a multivariate Cox proportional hazards model was performed to identify the independent prognostic factor. Anemic patients had a poorer OS compared with nonanemic patients after resection for tumor–nodes–metastasis ( TNM ) stage III tumors (5‐year OS rate: 32.2% vs. 45.7%, P  < 0.001) but not stage I ( P   =  0.480) or stage II ( P   =  0.917) tumors. Multivariate analysis revealed that preoperative anemia was an independent prognostic factor in TNM stage III (hazard ratio [ HR ], 1.771; 95% CI , 1.040–3.015; P  =   0.035). In a stage‐stratified analysis, preoperative anemia was still independently associated with OS in TNM stages III a through III c ( P  <   0.001, P  =   0.075, and P  =   0.012, respectively), though the association was only marginal in stage III b. Of note, preoperative mild anemia had a similar prognostic value in TNM stage III GC . Furthermore, preoperative anemia was significantly associated with more perioperative transfusions, postoperative complications and several nutritional‐based indices, including the prognostic nutritional index ( PNI ), preoperative weight loss and performance status (all P  <   0.05). Preoperative anemia, even mild anemia, was an important predictor of postoperative survival for TNM stage III GC .