Prognostic Significance of Degree of Anaemia and Blood Transfusions in Gastric Cancer Patients

Abstract

Background: Anaemia is a common complication of many solid tumours and occurs in approximately 41 % of patients with advanced gastric cancer at the time of diagnosis. Studies have shown that anaemia is an independent prognostic factor in gastric cancer, however it is less clear if blood transfusion alters the outcome in these patients. Aim of this study is to evaluate the effect of anaemia and blood transfusion on survival in advanced gastric cancer patients at our institution. Methods: This is a retrospective review of electronic medical records of gastric cancer patients treated from January to December 2013. Patients' demographics and clinical data was collected and analysed in relation to various factors including level of haemoglobin and use of blood transfusion. Survival was calculated using Univariate, multivariate and Kaplan-Meier survival analysis. Results: A total of 112 patients were identified including 79 (70%) males and 33 (30%) females with a median age of 73 years. Vast majority (n=88, 79%) of patients had locally advanced (T4 or node positive) disease at initial presentation. Eighty-three patients did not proceed to surgery after neoadjuvant chemotherapy due to inoperable disease. Initial Haemoglobin was >100 gram per litre in 28 (25%) patients. Nineteen patients had Haemoglobin of <80 gram per litre. 96 (86%) patients received blood transfusion. Overall, 98 (87.5%) patients died. The estimated median overall survival was 12 months (95% CI=11-81; 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 10 months (SD=20). Univariate analysis showed statistical significance of level of Hb and surgical resection to overall survival (P=0.0122 and P=0.0001). Multivariate analysis showed disease 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 blood transfusion. Our findings indicate the need for a consistent diagnostic and treatment approach to anaemia in this setting.