Faculty Collaboration Database

Preoperative Anemia, Transfusion, and Long-Term Oncologic Outcomes after Gastrectomy: Findings from the POWER4 Cohort. Ann Surg Oncol 2026 Feb;33(2):1360-1369

Date

10/19/2025

Pubmed ID

41110023

DOI

10.1245/s10434-025-18528-7

Scopus ID

2-s2.0-105023377559 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

BACKGROUND: Preoperative anemia and transfusion are common in gastric cancer surgery and have been associated with adverse short-term outcomes. Their impact on long-term oncologic prognosis remains unclear. We aimed to assess the association between preoperative anemia, perioperative red blood cell transfusion, and disease-free survival (DFS) after gastrectomy.

PATIENTS AND METHODS: This was a prespecified long-term analysis of the prospective POWER4 multicenter cohort conducted across 72 Spanish hospitals. Patients undergoing elective gastrectomy for gastric cancer between 2019 and 2020 were followed for ≥ 36 months. DFS was defined as time from surgery to recurrence or death. Primary exposures were preoperative anemia (World Health Organization criteria) and perioperative transfusion (within 72 h). Analyses included Kaplan-Meier estimates, multivariable Cox regression, logistic regression for delayed or omitted adjuvant chemotherapy (RIOT), and causal mediation analysis. Generalized additive models (GAMs) explored nonlinear associations between hemoglobin and DFS.

RESULTS: Among 386 patients, 47% had anemia and 28% received transfusion. In 368 with complete follow-up, DFS event rates ranged from 13% (no anemia/no transfusion) to 38% (anemia + transfusion) (p < 0.001). Both exposures were associated with DFS in univariable models but lost significance after adjustment. No hemoglobin threshold was identified. Among 149 eligible patients, RIOT was delayed or omitted in 41%, with neither exposure as independent predictors. Mediation analysis suggested transfusion explained 26% of the effect of anemia on DFS, though not significantly.

CONCLUSIONS: Anemia and transfusion were associated with adverse unadjusted outcomes, but not independently. This supports interpreting anemia as a marker of vulnerability rather than a modifiable risk factor for recurrence.

Author List

Ripollés-Melchor J, Abad-Motos A, García-Erce JA, Jericó C, Espinosa ÁV, Colomina MJ, Abad-Gurumeta A, Logroño-Ejea M, Galán-Menéndez P, Zorrilla-Vaca A, Batalla A, Fernández-García R, Paseiro-Crespo G, García-Álvarez R, de-Luis-Cabezón N, León-Bretscher A, García-Nebreda M, Bergés-Gutierrez H, Ruiz-Escobar A, Rábago-Moriyón JL, Gómez-Viana L, Gil-Gómez L, Gil-Trujillo S, Maroño-Boe MJ, Aldecoa C, POWER4 Investigators

Author

Angel Vicente Espinosa MD Assistant Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Anemia
Blood Transfusion
Erythrocyte Transfusion
Female
Follow-Up Studies
Gastrectomy
Humans
Male
Middle Aged
Neoplasm Recurrence, Local
Prognosis
Prospective Studies
Stomach Neoplasms
Survival Rate