Abstract
BACKGROUND: Advanced gastric cancer is characterized by fast tumor growth and aggressive biological behavior. During neoadjuvant chemotherapy, patients are at risk of distant metastasis or local progression. Anemia is a frequent complication in these patients. AIM: To analyze whether changes in hemoglobin and hematocrit can predict the survival and efficacy of neoadjuvant chemotherapy in patients with advanced gastric cancer. METHODS: The clinical data of 185 patients with advanced gastric cancer admitted to the Third Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, China, between January 2016 and January 2021, were retrospectively analyzed. All patients underwent a tegafur + oxaliplatin + apatinib chemotherapy regimen. According to the efficacy of chemotherapy, they were divided into an effective group (complete or partial response, n = 121) and an ineffective group (stable disease or disease progression, n = 64). The factors related to chemotherapy efficacy in patients with advanced gastric cancer were analyzed by univariate and logistic multivariate analyses. The 3-year survival rates of the patients with different hemoglobin and hematocrit levels were compared. RESULTS: Univariate analysis showed that the proportion of patients with a tumor diameter > 5 cm, non-tubular adenocarcinoma, lymph node metastasis, hematocrit < 33%, low mean red blood cell (RBC) protein content, low RBC distribution width, hemoglobin < 107 g/L, and platelets > 266 × 10(9)/L in the ineffective group were significantly higher than those in the effective group (P < 0.05). Logistic multivariate analysis showed that a tumor diameter > 5 cm, lymph node metastasis, ≤ 3 chemotherapy cycles, hematocrit < 33%, and hemoglobin < 107 g/L are risk factors for neoadjuvant chemotherapy failure in advanced gastric cancer (P < 0.05). The 1-year, 2-year, and 3-year survival rates in the effective group were 93.39%, 83.47%, and 60.33%, respectively. These rates were significantly higher than those in the ineffective group (P < 0.05). The 1-year, 2-year, and 3-year survival rates of patients with hematocrit < 33% were 74.67%, 49.33%, and 29.33%, respectively, which were significantly lower than those of patients with hematocrit ≥ 33% (P < 0.05). The 1-year, 2-year, and 3-year survival rates of patients with hemoglobin < 107 g/L were 80.39%, 58.82%, and 39.22%, respectively, which were significantly lower than those of patients with hemoglobin ≥ 107 g/L (P < 0.05). CONCLUSION: Hematocrit < 33% and hemoglobin < 107 g/L are risk factors for chemotherapy failure in patients with advanced gastric cancer. They are associated with poorer prognosis and reduced 3-year survival rates.