Association between serum transferrin and overall survival in cancer patients: a multi-center cohort study

Transferrin (Tf), a protein which is responsible for carrying iron in plasma reflected the nutritional status of patients. However, the relationship between serum Tf and survival of cancer patients has not been confirmed by large-scale studies. The cohort study includes 5546 patients from 40 clinical centers in China. The hazard ratio (HR) calculated by a Cox proportional hazard regression model is used to examine the association between serum Tf concentration and overall survival (OS). Kaplan–Meier curves are used to assess the relationship between Tf concentration and OS in cancer patients. Interaction analysis is utilized to explore the comprehensive influence of low serum Tf concentration and other factors on OS of cancer patients. Among all participants, there are 2567 (46.29%) women and 2979 (53.71%) men. The average age is 63.7 years old. The Tf concentration optimal cut‐off points of cancer patients is 1.92 g/L. Tf concentration is associated with overall cancer survival (HR:1.55,1.40–1.72, P < 0.001). By the multivariable Cox analysis, we find that Tf concentration is an independent risk factor (HR:1.21,1.09–1.36, P = 0.001) after adjusting other factors. For specific cancer types, low Tf concentration(< 1.92 g/L) is associated with poor overall survival of digestive, respiratory cancer, and other cancer patients (all P < 0.05). Low Tf concentration(< 1.92 g/L) has combined effects with male, smoking, low body mass index (BMI) or low albumin on unfavorable OS of cancer patients. On the basis of cut‐off points in our multi-center cohort, low Tf concentration(< 1.92 g/L) is significantly associated with lower OS in patients.