| Objective:(1)The case data of patients with advanced gastric cancer who were hospitalized for the first time in the Department of Hematology and Oncology,Dongzhimen Hospital of Beijing University of Chinese Medicine from January 1,2015 to December 30,2022 were collected retrospectively.Single factor analysis was used to screen out the related factors affecting anemia in patients with advanced gastric cancer,and the related factors were included in multivariate Logistics regression analysis to screen out the risk factors and protective factors affecting anemia in patients with advanced gastric cancer who first visited the hospital.(2)According to the comparison of clinical data of patients after 3 months,the patients were divided into three groups:anemia improvement group,anemia deterioration group and anemia stability group,and the clinical related data such as immune indicators were analyzed by one-way variance to explore the relationship between anemia changes and CD3+、CD3+CD4+、CD3+CD8+、CD3+CD4+CD25+/CD3+CD4+、CD3+CD4+CD25+FoxP3+/CD3+CD4+、CD3-CD19+、CD3-CD 16+CD56+in patients with advanced gastric cancer.The random forest model is used to rank the importance of influencing factors according to the mean decline Gini coefficient.Methods:The data of patients with advanced gastric cancer who were hospitalized for the first time in the Department of Hematology and Oncology,Dongzhimen Hospital,Beijing University of Chinese Medicine from January 1,2015 to December 30,2022 were collected retrospectively.Collect patients’ basic information,clinical data and laboratory examination.(1)To observe the influence of gender,age,KPS score,nutritional index(BMI),immunological index,tumor type and stage,and anti-tumor treatment methods on anemia.(2)The clinical data of patients with advanced gastric cancer who first visited the hospital were collected after three months of Chinese medicine treatment,and the changes of anemia were obtained.The patients were divided into three groups according to the changes of Hb:anemia improvement group,anemia deterioration group and anemia stability group,and the changes of anemia in patients with advanced gastric cancer after Chinese medicine treatment were preliminarily discussed.(3)According to the clinical data collected after three months of TCM treatment,the relationship between anemia and CD3+、CD3+CD4+、CD3+CD8+、CD3+CD4+CD25+/CD3+CD4+、CD3+CD4+CD25+FoxP3+/CD3+CD4+、CD3-CD19+、CD3-CD16+CD56+was analyzed.Results:A total of 117 patients with advanced gastric cancer were included in this study,of which 101 patients had follow-up data after 3 months.1 General situationA total of 101 patients with advanced gastric cancer were included in this study,including 54 patients with anemia at baseline(anemia group)and 47 patients without anemia at baseline(non-anemia group).There were 68 male patients and 33 female patients,the ratio of male to female was about 2:1.The age distribution ranged from 29 to 95 years old,with the most patients in the age group of 58 to 76 years old.The average KPS score is 80.The confirmed sites of gastric cancer were proximal stomach in 30 cases,body of stomach in 39 cases,distal stomach in 29 cases,whole stomach in 1 case and remnant stomach in 1 case.The pathological types of gastric cancer were adenocarcinoma in 88 cases,signet-ring cell carcinoma in 5 cases and squamous cell carcinoma in 1 case.The degree of differentiation is mainly low differentiation,with 48 cases,38 cases of moderate differentiation and 2 cases of high differentiation.89 cases were treated by western medicine and 12 cases were not treated by western medicine.2 Occurrence of anemiaGeneral situation of anemia:The incidence of anemia was 53.5%(54/101),and the incidence of mild,moderate,severe and extremely severe anemia was 16.8%(17/101),18.8%(19/101),8.9%(9/101)and 8.9%(9/101).Morphological classification showed that normal cell anemia accounted for 72.2%,large cell anemia accounted for 9.3%,and small cell anemia accounted for 18.5%.Individual factors and anemia:① Sex:The incidence of anemia in female patients was 51.5%(35/68),mainly mild and moderate anemia;The incidence of anemia in male patients was 57.6%(19/33),and the incidence of moderate anemia was high.The incidence of anemia in male patients was higher than that in female patients,with no statistical significance(P>0.2).② Age:The incidence of anemia was 53.2%(17/32)in the age ≤60 years old group;In the group over 60 years old,the incidence of anemia was 53.7%(37/69).The incidence of anemia in the group over 60 years old was higher than that in the group under 60 years old,and the difference was statistically significant(P<0.2).③KPS and anemia:KPS≤60,the incidence of anemia was 69.6%(16/23);When KPS>60 was grouped,the incidence of anemia was 48.0%.Compared with KPS>60 group,the incidence of anemia in KPS≤60 group was higher,and the difference was statistically significant(P<0.2).④BMI and anemia:In the BMI<18.5 kg/m2 group,the incidence of anemia was 44.9%,and the average Hb was 104.41±24.049g/L.In the BMI group of 18.5～23.9 kg/m2,the incidence of anemia was 58.5%,and the average Hb was 97.89±25.714 g/L.In the BMI>23.9 kg/m2 group,the incidence of anemia was 52.7%,and the average Hb of patients was 97.51±25.642 g/L,with no statistical significance(P>0.2).⑤ Peripheral blood lymphocyte count and classification and anemia:The average lymphocyte count in non-anemia group was 1.32±1.21×109/L,and that in anemia group was 0.97±0.51×109/L.The lymphocyte count in anemia group was significantly lower than that in non-anemia group,with statistical difference(P<0.2).The median ratio of CD3+between anemic group and anemic group was 70.7%vs70.9%,and there was no significant difference(P>0.2).The median ratio of CD3+CD4+between anemic group and anemic group(40.1%vs39.3%)was statistically significant(P<0.2).The median ratio of CD3+CD8+between anemic group and non-anemic group(23.3%vs21.9%)was not statistically significant(P>0.2).The median CD4/CD8 ratio between anemia group and non-anemia group(2.10%vs2.05%)showed no significant difference(P>0.2).The median ratio of CD3+CD4+CD25+/CD3+CD4+in peripheral blood between non-anemia group and anemia group(20.78%vs23.83%),and there was no significant difference(P>0.2).The median ratio of CD3+CD4+CD25+FoxP3+/CD3+CD4+in peripheral blood between anemia group and non-anemia group(4.31%vs4.46%),and there was no significant difference(P>0.2).The median ratio of CD3-CD19+in peripheral blood between anemia group and non-anemia group(9.93%vs9.76%),and there was no significant difference(P>0.2).The median ratio of CD3-CD16+CD56+in peripheral blood between non-anemia group and anemia group(9.83%vs ll.90%),and the difference was not statistically significant(P>0.2).Tumor characteristics and anemia:① The incidence of anemia in the primary site:stomach body,proximal stomach and distal stomach was 38.9%,29.6%and 29.6%respectively.Among them,the incidence of gastric anemia was the highest,and the difference was not statistically significant(P>0.2).② Degree of differentiation:The incidence of anemia in patients with low differentiation was the highest,accounting for 54%,followed by moderate differentiation and high differentiation,accounting for 44%and 2%respectively.The lower the differentiation,the higher the incidence of anemia,and the difference was not statistically significant(P>0.2).③ Metastasis and tumor load:The incidence of metastatic anemia in distant lymph nodes was 71.4%,that in liver was 55%,that in peritoneum was 57.9%,that in bone was 75%,that in lung was 66.7%,and that in other parts was 54.8%,with no statistical significance(P>0.2).The tumor load was defined according to the metastatic site and number of patients.The incidence of anemia was 47.1%only in lymph node metastasis,55.4%in single organ with or without lymph node metastasis and 53.6%in multiple organs with or without lymph node metastasis.The more metastatic sites and numbers,the higher the incidence of anemia,but the difference was not statistically significant(P>0.2).Therapy and anemia:The incidence of anemia was 58.3%in the group who never received anti-tumor therapy from western medicine,and 53.3%in the group who received anti-tumor therapy from western medicine.The incidence of anemia without anti-tumor treatment of western medicine was high,and the difference was not statistically significant(P>0.2).3 Statistical resultsUnivariate analysis of the risk of anemia showed that age,KPS,CD3+CD4+,MCV and MCH,and absolute value of lymphocytes were the influencing factors related to anemia,and the differences among different groups were statistically significant(P<0.2).Logistics regression model analysis showed that KPS(OR=0.97,95%CI:0.94-0.99)and absolute value of lymphocytes(OR=0.45,95%CI:0.19-0.95)were the protective factors for anemia,and the difference was statistically significant(P<0.05).The univariate analysis showed that the differences of CD3+CD4+CD25+FoxP3+/CD3+CD4+,CD3-CD16+CD56+,CRP,neutrophil absolute value and lymphocyte absolute value were the influencing factors of anemia,and the differences among the three groups were statistically significant(P<0.2).The comparison between groups showed that the absolute value of lymphocytes in the anemia improvement group had an upward trend,and the slope of the median line between the anemia deterioration group and the anemia stability group was larger,and it was statistically significant(P<0.05).The ratio of CD3+CD4+CD25+FoxP3+/CD3+CD4+in the anemia improvement group and the anemia stabilization group decreased,and the slope of the median line between the anemia improvement group and the anemia deterioration group was larger,with statistical difference(P<0.05).There was an upward trend of CD3-CD16+CD56+in the anemia improvement group,and the slope of the median line between the anemia improvement group and the anemia stability group was larger,but there was no statistical difference(P>0.05).There was an upward trend of CD3-CD19+in the anemia improvement group,and the slope of the median line between the anemia improvement group and the anemia deterioration group was larger,but there was no statistical difference(P>0.05).The random forest model shows that it is significant to predict the difference of CD3-CD16+,CD3-CD19+CD56+,CRP and lymphocyte absolute value by using the random forest model.The results of Sankitu showed that after the treatment of traditional Chinese medicine,only 9 of 54 anemia patients(16.7%)were aggravated after 3 months,while 14 patients(25.9%)had no obvious change in anemia compared with those when they entered the group,and 31 patients(57.4%)were better than before.Conclusions:Better physical condition and higher absolute value of lymphocytes in patients with advanced gastric cancer are protective factors for anemia.Chinese medicine treatment may improve anemia by adjusting the absolute value of lymphocytes and the ratio of CD3+CD4+CD25+FoxP3+/CD3+CD4+,CD3-CD16+CD56+and CD3-CD19+. |
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