Erythrocyte lifespan for predicting moderate and severe anemia in advanced gastric cancer patients post-anti-tumor therapeutics: a prospective study.

BACKGROUND

Anti-tumor Therapeutics often cause anemia in advanced gastric cancer (AGC) patients. Currently, anemia is often diagnosed based on hemoglobin levels, but these tests are reactive rather than predictive. Erythrocyte lifespan (ELS) a crucial physiological parameter, yet its relationship with anemia after anti-tumor treatment in AGC patients remains unclear. We aimed to investigate the potential of ELS in predicting the development of moderate and severe anemia in patients with AGC following anti-tumor therapeutics.

METHODS

56 AGC patients meeting specific criteria were enrolled from Oct 2023 to Oct 2024. ELS was determined with the Levitt's CO breath test-a non-invasive, bedside procedure. Correlations between ELS and various parameters were analyzed, t-tests were applied to analyze differences. The ROC curve was utilized to evaluate the predictive ability of ELS. Data analyzed via GraphPad Prism 9.0.0.

RESULTS

ELS was significantly positively correlated with hemoglobin, age, hematocrit, and mean corpuscular hemoglobin concentration, and negatively correlated with bilirubin. Patients with ELS less than 70 days had lower hemoglobin levels. The area under the ROC curve for ELS in predicting moderate and severe anemia 7-21 days after treatment was 0.8946, with an optimal cut-off value of 72.5 days.

CONCLUSION

For the first time, we demonstrate that baseline ELS can reliably forecast moderate-to-severe anemia 7-21 days after anti-tumor therapy in AGC advanced gastric cancer patients. This prospective proof-of-concept shifts anemia management from reactive hemoglobin monitoring to proactive risk stratification, enabling timely initiation of erythropoiesis-stimulating agents or iron supplementation and potentially reducing treatment interruptions.

TRIAL REGISTRATION: This trial was retrospectively registered at China Clinical Trials Registry (ChiCTR2500097950) on February 27, 2025.