Serum ferritin is associated with sarcopenia and predicts long-term survival for gastric cancer undergoing radical gastrectomy

Post-gastrectomy anemia and ferritin dynamics: key determinants of prognosis and clinical management in patients with gastric cancer

Objective

This study identified the trends and clinical significance of anemia and ferritin status 1 year postoperatively in patients with long-term survival and analyzed clinicopathological factors and preoperative nutritional/inflammatory conditions associated with anemia of chronic disease (ACD) development.

Methods

Between March 2009 and December 2018, 2,976 patients who underwent curative gastrectomy for gastric cancer without recurrence or mortality within postoperative 1 year were included. The patients were categorized into four groups; non-iron deficiency without anemia, iron deficiency without anemia, iron deficiency anemia (IDA), and ACD based on postoperative 1 year ferritin and hemoglobin.

Results

The overall incidence of anemia was 36.5% (n=1,086). The prevalence of IDA and ACD was 12.7% (n=377) and 23.8 (n=709), respectively, at postoperative 1 year. Patients with ACD were significantly older, had higher ECOG, increased early complications, and were at a more advanced stage than the other groups. The overall survival (OS) of ACD was significantly lower than that of the other groups (p < 0.001), especially for stages I and III. The presence of ACD was a significant risk factor for overall (hazard ratio [HR] = 1.832, p < 0.001), disease-free (HR= 1.714, p = 0.003), and cancer-specific (HR= 1.690, P = 0.015) survival. Older age, advanced disease stage, low preoperative prognostic nutritional index, preoperative anemia, and early postoperative complications were significant risk factors for ACD.

Conclusions

Relationship between ferritin and Hb at postoperative 1 year is a significant prognostic factor for survival in patients with gastric cancer. Particularly, ACD may be a specific predictor of gastric cancer. Therefore, clinicians need to pay attention to ACD status and prevent the risk factors for its development during long-term postoperative follow-up.

Construction of a diagnostic nomogram model for lymph node metastasis in gastric cancer based on human cartilage glycoprotein-39, carbohydrate antigen 50, and serum ferritin

BACKGROUND

Currently, the diagnostic efficacy of imaging techniques and traditional tumor markers for lymph node metastasis in gastric cancer is limited, necessitating the exploration of more innovative and non-invasive serological markers.

AIM

To construct a diagnostic model for lymph node metastasis in gastric cancer based on human cartilage glycoprotein-39 (YKL-40), carbohydrate antigen 50 (CA50), and serum ferritin (SF).

METHODS

A retrospective analysis was conducted on the clinical data of 120 gastric cancer patients admitted to Pan'an County People's Hospital from January 2020 to December 2023. The patients were divided into a metastatic group and a non-metastatic group based on postoperative pathological results. Clinical data, serum YKL-40, CA50, and SF were compared between the two groups. Lasso Logistic regression equation was used to screen for factors affecting gastric cancer lymph node metastasis. R software was used to construct a diagnostic nomogram model, and receiver operating characteristic curve, area under the curve (AUC), calibration curve, and decision curve analyses were performed to evaluate whether YKL-40 and CA50 were included or not, as well as the discrimination, calibration, and clinical net benefit of the nomogram model.

RESULTS

Pathological examination results showed that the incidence of lymph node metastasis in 120 cases of gastric cancer was 25.77%. The Lasso-Logistic regression equation showed that YKL-40 (odds ratio [OR]: 2.190), CA50 (OR: 3.173), SF (OR: 3.879), vascular invasion (OR: 3.039), TNM stage (OR: 4.854), and extent of lymph node dissection (OR: 3.855) were influencing factors of lymph node metastasis in gastric cancer (P < 0.05). Based on these influencing factors, a diagnostic nomogram model was drawn, with an AUC of 0.880 (95% confidence interval: 0.811-0.949). The calibration curve roughly coincided with the 45° reference line, providing additional clinical benefit within the range of 25% to 75%.

CONCLUSION

The diagnostic nomogram model based on YKL-40, CA50, and SF shows good performance in diagnosing lymph node metastasis in gastric cancer, which is helpful in guiding clinical diagnosis and treatment, and improving disease outcomes.

New Perspectives on Circulating Ferritin: Its Role in Health and Disease

The diagnosis of iron disturbances usually includes the evaluation of serum parameters. Serum iron is assumed to be entirely bound to transferrin, and transferrin saturation-the ratio between the serum iron concentration and serum transferrin-usually reflects iron availability. Additionally, serum ferritin is commonly used as a surrogate of tissue iron levels. Low serum ferritin values are interpreted as a sign of iron deficiency, and high values are the main indicator of pathological iron overload. However, in situations of inflammation, serum ferritin levels may be very high, independently of tissue iron levels. This presents a particularly puzzling challenge for the clinician evaluating the overall iron status of the patient in the presence of an inflammatory condition. The increase in serum ferritin during inflammation is one of the enigmas regarding iron metabolism. Neither the origin, the mechanism of release, nor the effects of serum ferritin are known. The use of serum ferritin as a biomarker of disease has been rising, and it has become increasingly diverse, but whether or not it contributes to controlling the disease or host pathology, and how it would do it, are important, open questions. These will be discussed here, where we spotlight circulating ferritin and revise the recent clinical and preclinical data regarding its role in health and disease.