Analysis of the incidence and influencing factors of anemia in patients with colorectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TONG Xin , SUN Xiong , JIANG Qi , ZENG Xiangyu , YIN Yuping , LIU Weizhen , ZHANG Peng , WANG Zheng , LONG Yueping , GAO Jinbo , CAI Kailin , WANG Guobin ,  TAO Kaixiong

Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P. R. China;

Corresponding author：

TAO Kaixiong, Email: kaixiongtao@hust.edu.cn

Keywords：

colorectal cancer; anemia; perioperative period; incidence; influencing factor

DOI：

10.7507/1007-9424.202104001

Video：

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Objective To investigate the incidence of perioperative anemia and the influencing factors of preoperative anemia in patients with colorectal cancer.Methods The clinicopathological data of 1 250 patients with colorectal cancer who underwent surgery in our hospital from January 1, 2019 to December 31, 2019 were analyzed retrospectively. According to the preoperative hemoglobin level, patients were divided into anemia group and non-anemia group. Univariate analysis and multivariate logistic regression analysis were used to explore the influencing factors of preoperative anemia in patients with colorectal cancer, and the effects of preoperative anemia on intraoperative blood transfusion, postoperative complications, and postoperative hospital stay were analyzed.Results The incidence of preoperative anemia in patients with colorectal cancer was 40.6% (508/1 250), and the incidence of preoperative anemia in patients with right colon cancer, left colon cancer, and rectal cancer was 66.0% (192/291), 41.1% (139/338), and 28.5% (177/621), respectively. The incidence of postoperative anemia in patients with colorectal cancer was 69.4% (867/1 250), and the incidence of postoperative anemia in patients with right colon cancer, left colon cancer, and rectal cancer was 81.8% (238/291), 68.9% (233/338), and 63.8% (396/621), respectively. Multivariate logistic regression analysis showed that age >60 years old, nutritional risk screening 2002 ≥3, right colon cancer, T3–4 stage, and M1 stage were risk factors for preoperative anemia in patients with colorectal cancer (P<0.05). The rate of intraoperative blood transfusion and the incidence of postoperative complications in the preoperative anemia group of patients with colorectal cancer were higher than those in the non-anemia group (P<0.05). The postoperative hospital stay in the preoperative anemia group of patients with colon cancer was longer than that in the non-anemia group (P<0.05).Conclusions The incidence of perioperative anemia in patients with colorectal cancer is high. Advanced age, high nutritional risk, right colon cancer, T3–4 stage, and distant metastasis were the risk factors of preoperative anemia in patients with colorectal cancer. Preoperative anemia can increase the demand for intraoperative blood transfusion and the incidence of postoperative complications in patients with colorectal cancer, and prolong postoperative hospital stay of colon cancer patients.

Citation： TONG Xin, SUN Xiong, JIANG Qi, ZENG Xiangyu, YIN Yuping, LIU Weizhen, ZHANG Peng, WANG Zheng, LONG Yueping, GAO Jinbo, CAI Kailin, WANG Guobin, TAO Kaixiong. Analysis of the incidence and influencing factors of anemia in patients with colorectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(8): 1003-1008. doi: 10.7507/1007-9424.202104001 Copy

1.	Zhang S, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2015. JNCC, 2020, 1(1): 2-11.
2.	中华医学会外科学分会, 中华外科杂志编辑委员会. 普通外科围手术期缺铁性贫血管理多学科专家共识. 中华外科杂志, 2020, 58(4): 252-256.
3.	Ristescu I, Pintilie G, Filip D, et al. Perioperative anemia and transfusion in colorectal cancer patients. Chirurgia (Bucur), 2019, 114(2): 234-242.
4.	Yeap E, Teoh WMK, Nguyen TC, et al. Preoperative anaemia and thrombocytopenia are associated with venous thromboembolism complications after colorectal resection. ANZ J Surg, 2021, 91(1-2): E32-E37.
5.	Bartoszko J, Thorpe KE, Laupacis A, et al. Association of preoperative anaemia with cardiopulmonary exercise capacity and postoperative outcomes in noncardiac surgery: a substudy of the Measurement of Exercise Tolerance before Surgery (METS) Study. Br J Anaesth, 2019, 123(2): 161-169.
6.	Bufill JA. Colorectal cancer: evidence for distinct genetic categories based on proximal or distal tumor location. Ann Intern Med, 1990, 113(10): 779-788.
7.	Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin, 2017, 67(2): 93-99.
8.	宋正波, 陆舜, 冯继锋, 等. 中国肿瘤相关性贫血发生率及治疗现状的流行病学调查研究. 中国肿瘤, 2019, 28(9): 718-722.
9.	Hufnagel DH, Mehta ST, Ezekwe C, et al. Prevalence of anemia and compliance with NCCN guidelines for evaluation and treatment of anemia in patients with gynecologic cancer. J Natl Compr Canc Netw, 2021 Feb 1, Online ahead of print.
10.	Burton BN, Okwuegbuna O, Jafari A, et al. Association of preoperative anemia with 30-day morbidity and mortality among patients with thyroid cancer who undergo thyroidectomy. JAMA Otolaryngol Head Neck Surg, 2019, 145(2): 124-131.
11.	Bruns ERJ, Borstlap WA, van Duijvendijk P, et al. The association of preoperative anemia and the postoperative course and oncological outcome in patients undergoing rectal cancer surgery: A multicenter snapshot study. Dis Colon Rectum, 2019, 62(7): 823-831.
12.	Kwon YH, Lim HK, Kim MJ, et al. Impacts of anemia and transfusion on oncologic outcomes in patients undergoing surgery for colorectal cancer. Int J Colorectal Dis, 2020, 35(7): 1311-1320.
13.	Kwon HY, Kim BR, Kim YW. Association of preoperative anemia and perioperative allogenic red blood cell transfusion with oncologic outcomes in patients with nonmetastatic colorectal cancer. Curr Oncol, 2019, 26(3): e357-e366.
14.	Stauder R, Valent P, Theurl I. Anemia at older age: etiologies, clinical implications, and management. Blood, 2018, 131(5): 505-514.
15.	Chueh HW, Jung HL, Shim YJ, et al. High anemia prevalence in Korean older adults, an advent healthcare problem: 2007-2016 KNHANES. BMC Geriatr, 2020, 20(1): 509.
16.	Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr, 2003, 22(4): 415-421.
17.	朱磊, 胡松, 徐华, 等. 术前营养风险筛查对结肠癌患者围手术期营养支持的临床意义. 中国普外基础与临床杂志, 2015, 22(6): 700-704.
18.	Lee GH, Malietzis G, Askari A, et al. Is right-sided colon cancer different to left-sided colorectal cancer? - A systematic review. Eur J Surg Oncol, 2015, 41(3): 300-308.
19.	杨景文, 张庆怀, 刘彤. 右半与左半结肠癌临床特征变化研究及预后分析. 中国实用外科杂志, 2014, 34(9): 866-870.
20.	于健春, 葛军娜, 唐云, 等. 胃、结直肠癌患者手术前后贫血状况的多中心临床调查研究. 中华外科杂志, 2011, 49(1): 53-56.
21.	胡继霖, 卢云. 左、右半结肠癌的差异. 中华结直肠疾病电子杂志, 2018, 7(6): 514-517.
22.	Fraenkel PG. Anemia of inflammation: a review. Med Clin North Am, 2017, 101(2): 285-296.
23.	Zhao L, He R, Long H, et al. Late-stage tumors induce anemia and immunosuppressive extramedullary erythroid progenitor cells. Nat Med, 2018, 24(10): 1536-1544.
24.	Jing A, Vizeacoumar FS, Parameswaran S, et al. Expression-based analyses indicate a central role for hypoxia in driving tumor plasticity through microenvironment remodeling and chromosomal instability. NPJ Syst Biol Appl, 2018, 4: 38.
25.	Bhandari V, Hoey C, Liu LY, et al. Molecular landmarks of tumor hypoxia across cancer types. Nat Genet, 2019, 51(2): 308-318.

1. Zhang S, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2015. JNCC, 2020, 1(1): 2-11.
2. 中华医学会外科学分会, 中华外科杂志编辑委员会. 普通外科围手术期缺铁性贫血管理多学科专家共识. 中华外科杂志, 2020, 58(4): 252-256.
3. Ristescu I, Pintilie G, Filip D, et al. Perioperative anemia and transfusion in colorectal cancer patients. Chirurgia (Bucur), 2019, 114(2): 234-242.
4. Yeap E, Teoh WMK, Nguyen TC, et al. Preoperative anaemia and thrombocytopenia are associated with venous thromboembolism complications after colorectal resection. ANZ J Surg, 2021, 91(1-2): E32-E37.
5. Bartoszko J, Thorpe KE, Laupacis A, et al. Association of preoperative anaemia with cardiopulmonary exercise capacity and postoperative outcomes in noncardiac surgery: a substudy of the Measurement of Exercise Tolerance before Surgery (METS) Study. Br J Anaesth, 2019, 123(2): 161-169.
6. Bufill JA. Colorectal cancer: evidence for distinct genetic categories based on proximal or distal tumor location. Ann Intern Med, 1990, 113(10): 779-788.
7. Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin, 2017, 67(2): 93-99.
8. 宋正波, 陆舜, 冯继锋, 等. 中国肿瘤相关性贫血发生率及治疗现状的流行病学调查研究. 中国肿瘤, 2019, 28(9): 718-722.
9. Hufnagel DH, Mehta ST, Ezekwe C, et al. Prevalence of anemia and compliance with NCCN guidelines for evaluation and treatment of anemia in patients with gynecologic cancer. J Natl Compr Canc Netw, 2021 Feb 1, Online ahead of print.
10. Burton BN, Okwuegbuna O, Jafari A, et al. Association of preoperative anemia with 30-day morbidity and mortality among patients with thyroid cancer who undergo thyroidectomy. JAMA Otolaryngol Head Neck Surg, 2019, 145(2): 124-131.
11. Bruns ERJ, Borstlap WA, van Duijvendijk P, et al. The association of preoperative anemia and the postoperative course and oncological outcome in patients undergoing rectal cancer surgery: A multicenter snapshot study. Dis Colon Rectum, 2019, 62(7): 823-831.
12. Kwon YH, Lim HK, Kim MJ, et al. Impacts of anemia and transfusion on oncologic outcomes in patients undergoing surgery for colorectal cancer. Int J Colorectal Dis, 2020, 35(7): 1311-1320.
13. Kwon HY, Kim BR, Kim YW. Association of preoperative anemia and perioperative allogenic red blood cell transfusion with oncologic outcomes in patients with nonmetastatic colorectal cancer. Curr Oncol, 2019, 26(3): e357-e366.
14. Stauder R, Valent P, Theurl I. Anemia at older age: etiologies, clinical implications, and management. Blood, 2018, 131(5): 505-514.
15. Chueh HW, Jung HL, Shim YJ, et al. High anemia prevalence in Korean older adults, an advent healthcare problem: 2007-2016 KNHANES. BMC Geriatr, 2020, 20(1): 509.
16. Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr, 2003, 22(4): 415-421.
17. 朱磊, 胡松, 徐华, 等. 术前营养风险筛查对结肠癌患者围手术期营养支持的临床意义. 中国普外基础与临床杂志, 2015, 22(6): 700-704.
18. Lee GH, Malietzis G, Askari A, et al. Is right-sided colon cancer different to left-sided colorectal cancer? - A systematic review. Eur J Surg Oncol, 2015, 41(3): 300-308.
19. 杨景文, 张庆怀, 刘彤. 右半与左半结肠癌临床特征变化研究及预后分析. 中国实用外科杂志, 2014, 34(9): 866-870.
20. 于健春, 葛军娜, 唐云, 等. 胃、结直肠癌患者手术前后贫血状况的多中心临床调查研究. 中华外科杂志, 2011, 49(1): 53-56.
21. 胡继霖, 卢云. 左、右半结肠癌的差异. 中华结直肠疾病电子杂志, 2018, 7(6): 514-517.
22. Fraenkel PG. Anemia of inflammation: a review. Med Clin North Am, 2017, 101(2): 285-296.
23. Zhao L, He R, Long H, et al. Late-stage tumors induce anemia and immunosuppressive extramedullary erythroid progenitor cells. Nat Med, 2018, 24(10): 1536-1544.
24. Jing A, Vizeacoumar FS, Parameswaran S, et al. Expression-based analyses indicate a central role for hypoxia in driving tumor plasticity through microenvironment remodeling and chromosomal instability. NPJ Syst Biol Appl, 2018, 4: 38.
25. Bhandari V, Hoey C, Liu LY, et al. Molecular landmarks of tumor hypoxia across cancer types. Nat Genet, 2019, 51(2): 308-318.

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