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.

中文翻译：

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术前铁状态是 II 期和 III 期结直肠癌的预后因素

背景

缺铁性贫血以结直肠癌 (CRC) 患者为代表。铁过剩负荷增加非转铁蛋白结合铁 (NTBI)，NTBI 促进癌症进展并影响微生物群。本研究调查了术前血清铁状态是否与 CRC 切除术后的预后相关。

方法

我们评估了 327 名接受 II-III 期 CRC 手术的患者的术前铁和转铁蛋白饱和度 (TSAT)，其计算方法为铁除以总铁结合能力。Fe < 60 μg/dl 和 TSAT > 40% 分别定义为低铁和高铁。在单变量和多变量 Cox 比例风险分析中评估了铁状态与总生存期 (OS) 之间的关联。

结果

在 327 名患者中，分别有 179 名 (54.7%)、124 名 (37.9%) 和 24 名 (7.3%) 铁含量低、正常和高。在单变量分析中，低铁与较短的 OS 相关（风险比 [HR] 2.821，95% 置信区间 [CI] 1.451–5.485，P  = 0.002）。高铁还与较短的 OS 相关（HR 3.396，95% CI 1.359–8.489，P  = 0.009）。在多变量分析中，高年龄 ( P  = 0.002)、浸润深度 pT4 ( P  = 0.012)、存在淋巴结转移 ( P  = 0.035)、低白蛋白 ( P  = 0.011)、低铁 (HR 2.282, 95% CI) 1.163–4.478, P  = 0.016) 和高铁 (HR 3.757, 95% CI 1.486–9.494 P = 0.005) 与较短的 OS 独立相关。与正常铁相比，高铁与瘤内具核梭杆菌的数量有关。

结论

在单变量和多变量分析中，II-III 期 CRC 患者术前低铁和高铁均与不利的 OS 相关。