Preoperative Hemoglobin Level and Iron Status as Predictors of Prognosis in Gastric Cancer Surgery

Background/Aim: This study aimed to evaluate the association between clinicopathological features, iron status, and prognosis in patients undergoing gastrectomy for gastric cancer. Patients and Methods: We retrospectively analyzed 634 patients who underwent gastrectomy between 2014 and 2023. Anemia was defined by World Health Organization criteria (Hb <12.0 g/dl in women, <13.0 g/dl in men). Survival outcomes were assessed using Kaplan–Meier and Cox proportional hazards models. Results: Preoperative anemia was present in 61.8% of patients. The 5-year overall survival rate was significantly lower in patients with anemia (62.0% vs. 78.0%; p=0.001) and those receiving blood transfusion (44.7% vs. 73.9%; p<0.001). Multivariate analysis identified stage, age, and comorbidities as independent prognostic factors. Although anemia was not an independent factor considering the entire cohort, stage-stratified analysis revealed that in patients with stage I/II disease, the 5-year overall survival rate was significantly lower in the group with anemia (83.0% vs. 93.8%; p=0.024). Hemoglobin levels were significantly positively correlated with serum iron (r=0.554) and albumin (r=0.555) levels. Conclusion: Preoperative anemia is highly prevalent and significantly associated with poor long-term survival, particularly in stage I/II gastric cancer. As a modifiable risk factor reflecting physiological reserve, preoperative optimization of the hemoglobin level may improve outcomes in this population.