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Preoperative iron status is a prognosis factor for stage II and III colorectal cancer

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Abstract

Background

Iron deficiency anemia is represented in colorectal cancer (CRC) patients. Iron surplus load to increase non-transferrin bound iron (NTBI), and NTBI promotes cancer progression and influences microbiota. This study investigated whether preoperative serum iron status was associated with prognosis after CRC resection.

Methods

We evaluated preoperative iron and transferrin saturation (TSAT), which was calculated as iron divided by total iron-binding capacity, in 327 patients who underwent surgery for Stage II–III CRC. Fe < 60 μg/dl and TSAT > 40% were defined as low and high iron, respectively. The associations between iron status and overall survival (OS) were evaluated in univariate and multivariate Cox proportional hazards analysis.

Results

Of the 327 patients, 179 (54.7%), 124 (37.9%) and 24 (7.3%) had low, normal and high iron, respectively. In univariate analysis, low iron was associated with shorter OS (hazard ratio [HR] 2.821, 95% confidence interval [CI] 1.451–5.485, P = 0.002). High iron was also associated with shorter OS (HR 3.396, 95% CI 1.359–8.489, P = 0.009). In multivariate analysis, high age (P = 0.002), depth of invasion pT4 (P = 0.012), lymph-node metastasis presence (P = 0.035), low albumin (P = 0.011), low iron (HR 2.282, 95% CI 1.163–4.478, P = 0.016) and high iron (HR 3.757, 95% CI 1.486–9.494 P = 0.005) were independently associated with shorter OS. High iron was associated with the amount of intratumoral Fusobacterium nucleatum compared with normal iron.

Conclusion

Both low and high preoperative iron in Stage II–III CRC patients were associated with unfavorable OS in univariate and multivariate analyses.

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Acknowledgements

The authors thank Drs. Kenichi Iyama and Yoshiki Mikami for the pathological diagnoses. The authors also thank Mototsugu Shimokawa for the statistical analysis of the data.

Funding

This work was supported by JSPS KAKENHI (Grant Numbers 19K09199).

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Correspondence to Hideo Baba.

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No author has any conflict of interest.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. All patients gave informed consent for being included in the study.

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Supplementary file1 (DOCX 39 KB)

10147_2021_1995_MOESM2_ESM.pptx

Supplementary Figure S1. Kaplan–Meier curve of overall survival in patients with colorectal cancer who have undergone colorectal resection according to preoperative (A) and intraoperative (B) blood transfusion (PPTX 125 KB)

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Sawayama, H., Miyamoto, Y., Mima, K. et al. Preoperative iron status is a prognosis factor for stage II and III colorectal cancer. Int J Clin Oncol 26, 2037–2045 (2021). https://doi.org/10.1007/s10147-021-01995-9

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  • DOI: https://doi.org/10.1007/s10147-021-01995-9

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