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Preoperative transferrin level is a novel indicator of short- and long-term outcomes after esophageal cancer surgery

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Abstract

Background

This study aimed to examine whether preoperative serum transferrin, a rapid-turnover protein, correlates with short- and long-term outcomes after esophagectomy.

Methods

Preoperative transferrin levels, calculated by summing serum iron and unsaturated iron-binding capacity, were evaluated in 224 patients who underwent esophagectomy for stage I–III esophageal cancer without preoperative treatment. Transferrin levels are directly proportional to total iron-binding capacity (TIBC), and we defined TIBC < 250 μg/dL as low transferrin. We evaluated the relationship between preoperative transferrin levels and short- and long-term outcomes after esophagectomy using univariate and multivariate Cox proportional hazards analyses.

Results

Of all patients, 25 (11.2%) had low preoperative transferrin levels. Low preoperative transferrin levels were strongly correlated with worse preoperative performance status, advanced pathological T stage, and more open esophagectomy (p = 0.0078, 0.0001, and 0.013, respectively). Patients with low preoperative transferrin levels experienced significantly more frequent postoperative pneumonia in univariate and multivariate analysis [hazard ratio (HR) 3.30, 95% confidence interval (CI) 1.032–10.033, p = 0.0443]. Additionally, these patients were significantly correlated with worse overall survival (OS) in univariate and multivariate analyses (HR 2.75, 95% CI 1.018–7.426, p = 0.0460). Furthermore, we investigated the relationship between OS and postoperative pneumonia to elucidate why low preoperative transferrin, which is an independent risk factor for postoperative pneumonia, leads to poor prognosis. Patients with postoperative pneumonia were strongly associated with a shorter OS (p = 0.0099).

Conclusion

Preoperative serum transferrin levels may be a novel indicator of postoperative pneumonia and OS after esophagectomy.

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Acknowledgements

The authors thank all the people who contributed to this work.

Funding

There was no financial support for this research.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan

    Taishi Yamane, Hiroshi Sawayama, Naoya Yoshida, Takeshi Morinaga, Takahiko Akiyama, Kojiro Eto, Kazuto Harada, Katsuhiro Ogawa, Masaaki Iwatsuki, Shiro Iwagami, Yoshifumi Baba, Yuji Miyamoto & Hideo Baba

Authors
  1. Taishi Yamane
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  2. Hiroshi Sawayama
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  3. Naoya Yoshida
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  4. Takeshi Morinaga
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  5. Takahiko Akiyama
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  11. Yoshifumi Baba
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  13. Hideo Baba
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Contributions

TY wrote the manuscript. HS planed study concept and design. TM, TA, KE, KH, and KO collected the clinical data. MI, SI, YB and YM conducted critical revision of manuscript. NY and HB coordinated the study, oversaw collection and analysis of the results. All authors discussed the data and commented on the manuscript.

Corresponding author

Correspondence to Hideo Baba.

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The authors declare that they have no conflict of interest.

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This study was approved by the institutional ethics committee (Registry Number 1909).

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Yamane, T., Sawayama, H., Yoshida, N. et al. Preoperative transferrin level is a novel indicator of short- and long-term outcomes after esophageal cancer surgery. Int J Clin Oncol 27, 131–140 (2022). https://doi.org/10.1007/s10147-021-02031-6

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  • DOI: https://doi.org/10.1007/s10147-021-02031-6

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