Elevated red cell distribution width contributes to a poor prognosis in patients with esophageal carcinoma

Red blood cell distribution width has a prognostic value for gastric cancer patients after gastrectomy: A pooling-up analysis

Our study aims to investigate whether preoperative red blood cell distribution width (RDW) has a prognostic value for patients after gastric cancer (GC) surgery. We searched articles in 3 databases including PubMed, Embase, and the Cochrane Library on May 16th, 2022. The prognostic indicators included overall survival (OS) and disease-free survival (DFS). RevMan 5.3 (The Cochrane Collaboration, London, United Kingdom) and Stata V16.0 were used for statistical analysis. The Risk Of Bias In Non-randomized Studies-of Interventions tool was used to assess risk of bias of the included studies. Ten articles involving 2740 patients were included. RDW was a prognostic factor for OS (hazard ratio = 1.81, 95% confidence interval [CI] = 1.38-2.37, P < .01) and DFS (hazard ratio = 1.99, I2 = 26%, 95% CI = 1.53-2.58, P < .01) for GC patients. Meanwhile, there were some differences between the high RDW group and the low RDW group. We found more patients older than 60 years old (OR = 2.58, 95% CI = 1.08-6.13, P = .03), larger tumor diameter (OR = 1.95, 95% CI = 1.33-2.85, P < .01) and later T stage (OR = 1.91, 95% CI = 1.07-3.42, P = .03) in the high RDW group than the low RDW group. No statistic difference was found in gender, N stage, tumor node metastasis stage, vascular invasion, differentiation, and adjuvant therapy between the 2 groups (P > .05). RDW was an independent prognostic factor for both OS and DFS of GC patients. High RDW level were strongly associated with poor survival.

Does red blood cell distribution width predict prognosis in metastatic renal cell carcinoma patients using first-line vascular endothelial growth factor receptor tyrosine kinase inhibitor therapy?

Aim

It is red cell distribution width (RDW) that has been reported to show an inflammatory response which has been studied recently. The aim of this study is to investigate whether the pre-treatment RDW in patients using first-line vascular endothelial growth factor tyrosine kinase inhibitor (VEGFR TKI) with the diagnosis of metastatic renal cell carcinoma (mRCC) predicts treatment response and is a prognostic factor or not.

Methods

About 92 patients diagnosed with mRCC who were being treated with sunitinib or pazopanib in the first line between January 2015 and June 2021 were included in the study. The patients were divided into 2 groups, as being ≤15.3 and >15.3, according to the RDW cut-off value calculated by ROC analysis.

Results

The mOS of patients with a RDW of ≤15.3% was 45.0 (30.0-59.9) months, and of 21.3 (10.4-32.2) in those with a RDW of >15.3%. This difference was statistically significant (p < 0.001). In the group of patients with a RDW of ≤15.3, median progression free survival (mPFS) (38.04 [16.3-59.7] months) was found to be significantly higher than those with a RDW of >15.3 (17.1 [11.8-22.5] months) (p = 0.04). In multivariate analysis, RDW level (≤15.3, >15.3), was determined to be prognostic markers (p = 0.022).

Conclusion

In mRCC patients, the RDW value measured before first-line VEGFR TKI therapy is an independent prognostic marker.

A New Online Dynamic Nomogram: Construction and Validation of an Assistant Decision-Making Model for Laryngeal Squamous Cell Carcinoma

Background

Laryngeal squamous cell carcinoma (LSCC) is the most common type of head and neck squamous cell carcinoma. However, there are currently no reliable biomarkers for the diagnosis and prognosis of LSCC. Thus, this study aimed to identify the independent risk factors and develop and validate a new dynamic web-based nomogram that can predict auxiliary laryngeal carcinogenesis.

Methods

Data on the medical history of 221 patients who were recently diagnosed with LSCC and 359 who were recently diagnosed with benign laryngeal lesions (BLLs) at the First Affiliated Hospital of Anhui Medical University were retrospectively reviewed. Using the bootstrap method, 580 patients were divided in a 7:3 ratio into a training cohort (LSCC, 158 patients; BLL, 250 patients) and an internal validation cohort (LSCC, 63 patients; BLL, 109 patients). In addition, a retrospective analysis of 31 patients with LSCC and 54 patients with BLL from Fuyang Hospital affiliated with Anhui Medical University was performed as an external validation cohort. In the training cohort, the relevant indices were initially screened using univariate analysis. Then, least absolute shrinkage and selection operator logistic analysis was used to evaluate the significant potential independent risk factors (P<0.05); a dynamic online diagnostic nomogram, whose discrimination was evaluated using the area under the ROC curve (AUC), was constructed, while the consistency was evaluated using calibration plots. Its clinical application was evaluated by performing a decision curve analysis (DCA) and validated by internal validation of the training set and external validation of the validation set.

Results

Five independent risk factors, sex (odds ratio [OR]: 6.779, P<0.001), age (OR: 9.257, P<0.001), smoking (OR: 2.321, P=0.005), red blood cell width distribution (OR: 2.698, P=0.001), albumin (OR: 0.487, P=0.012), were screened from the results of the multivariate logistic analysis of the training cohort and included in the LSCC diagnostic nomogram. The nomogram predicted LSCC with AUC values of 0.894 in the training cohort, 0.907 in the internal testing cohort, and 0.966 in the external validation cohort. The calibration curve also proved that the nomogram predicted outcomes were close to the ideal curve, the predicted outcomes were consistent with the real outcomes, and the DCA curve showed that all patients could benefit. This finding was also confirmed in the validation cohort.

Conclusion

An online nomogram for LSCC was constructed with good predictive performance, which can be used as a practical approach for the personalized early screening and auxiliary diagnosis of the potential risk factors and assist physicians in making a personalized diagnosis and treatment for patients.

Prognostic Value of Pretreatment Red Blood Cell Distribution Width in Patients With Esophageal Cancer Who Underwent Esophagectomy: A Retrospective Study

Objective

This comprehensive analysis aimed to elucidate the mechanism underlying how high pretreatment red blood cell distribution width (RDW) reflects poor prognosis after esophagectomy for esophageal cancer.

Background

Several cohort studies have reported that preoperative RDW might be a predictive marker for poor prognosis after esophagectomy; however, the underlying mechanism of this relationship has not been elucidated.

Methods

This study included 626 patients with esophageal cancer who underwent esophagectomy between April 2005 and November 2020. A retrospective investigation of the association between pretreatment RDW and clinicopathological features, blood data, short-term outcomes, and prognosis was conducted using a prospectively entered institutional clinical database and the latest follow-up data.

Results

Of 626 patients, 87 (13.9%) had a high pretreatment RDW. High RDW was significantly associated with several disadvantageous characteristics regarding performance status, the American Society of Anesthesiologists physical status, respiratory comorbidity, and nutritional status. Similarly, high RDW correlated with frequent postoperative morbidities (respiratory morbidity and reoperation; P = 0.022 and 0.034, respectively), decreased opportunities for adjuvant chemotherapy (P = 0.0062), and increased death from causes other than esophageal cancer (P = 0.046). Finally, RDW could be an independent predictor of survival after esophagectomy (hazard ratio, 1.47; 95% confidence interval, 1.009-2.148; P = 0.045).

Conclusion

High pretreatment RDW reflected various adverse backgrounds and it could be a surrogate marker of poor prognosis in patients who have undergone esophagectomy for esophageal cancer.

Associations of Complete Blood Count Parameters with Disease-Free Survival in Right- and Left-Sided Colorectal Cancer Patients

Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. Some complete blood count (CBC) parameters are found to be associated with CRC prognosis. In this study, ninety-seven pretreated CRC patients were included, and the patients were divided into two groups: left-sided and right-sided, depending on the anatomical location of the tumor. Based on clinicopathologic features including tumor budding, disease stages, and tumor anatomical location, levels of CBC parameters were compared, and disease-free survivals (DFS) were determined. There were differences between patients with different tumor budding scores for only three parameters, including red cell distribution width (RDW), numbers of platelets, and mean platelet volume (MPV). Furthermore, numbers of WBCs, monocytes, and MPV in CRC patients with early disease stages were higher than those with advanced stages. However, levels of eosinophil in CRC patients with advanced stages were higher than those with early stages. Depending on the tumor anatomical location, we observed that numbers of red blood cells (RBCs), hemoglobin (Hgb), and hematocrit (Hct) in CRC patients with left-sided tumors were higher than those with right-sided tumors. We found that low levels of MPV were associated with shorter DFS. However, high levels of eosinophils were associated with shorter DFS in all CRC patients. When patients were divided based on the tumor anatomical location, higher levels of MPV, MCHC, and Hgb were associated with better DFS in the left-sided but not right-sided CRC patients. However, left-sided, but not right-sided, CRC patients with high levels of eosinophil and RDW had shorter DFS. Furthermore, right-sided, but not left-sided, CRC patients with high levels of platelets tended to have a shorter DFS. Our data show that MPV and eosinophils could serve as potential prognostic biomarkers in pre-treatment CRC patients, regardless of the tumor anatomical location. Additionally, lower levels of MPV, MCHC, and Hgb, and high levels of eosinophils and RDW could be negative predictive biomarkers in left-sided CRC patients.

Clinical importance of preoperative red-cell volume distribution width as a prognostic marker in patients undergoing radical surgery for pancreatic cancer

Background and purpose

A new noninvasive biomarker is being sought to predict the prognosis of patients with pancreatic cancer. Red-cell volume distribution width (RDW), a descriptive parameter for erythrocyte variation, has been shown to have prognostic value for some tumor types. Our purpose was to assess the RDW value to predict the prognosis of patients with pancreatic cancer.

Methods

The subjects of this retrospective study were 792 patients who underwent radical surgery for pancreatic cancer, divided into high-RDW and low-RDW groups based on receiver operating characteristic (ROC) curve analysis (15.6%). The controlling nutritional status (CONUT) score was used to assess preoperative nutritional status. Statistical analysis was conducted to investigate the differences between the high and low RDW groups, and to explore the possibility of the RDW being used as prognostic predictor for patients with pancreatic cancer.

Results

The immune-nutritional status was worse in the high-RDW group than in the low-RDW group. The high-RDW group patients also had a poorer prognosis. Risk factor analysis showed that the RDW could be an independent risk factor for pancreatic cancer.

Conclusions

The RDW is associated with immune-nutritional status in pancreatic cancer patients and can be used as an independent prognostic factor for their postoperative survival.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00595-021-02374-7.

Prognostic effect of preoperative red cell distribution width on the survival of patients who have undergone surgery for non-small cell lung cancer

Red cell distribution width (RDW) is a prognostic factor for various malignancies, including colorectal, breast and lung cancer. The effect of preoperative RDW on the prognosis of patients who have undergone surgery for non-small cell lung cancer (NSCLC) was investigated in the present study. This retrospective, single-institution study included consecutive patients who had undergone complete NSCLC resection between January 2006 and December 2013 at the Department of Thoracic Surgery of Kansai Medical University Hospital (Hirakata, Japan). The overall and recurrence-free survival rates were compared using univariate and multivariate Cox proportional hazard models. A stepwise backward elimination method with a probability level of 0.15 was performed to select the most powerful outcome predictor sets. A total of 338 cases with NSCLC were analyzed. Of these, 25 had high RDWs (≥50 fl) and 313 had low RDWs (<50 fl). The 5-year overall survival rates in patients with high and low RDWs were 0.40 [95% confidence interval (CI): 0.21-0.58] and 0.80 (95% CI: 0.76-0.84), respectively, and the recurrence-free survival rates were 0.48 (95% CI: 0.25-0.68) and 0.70 (95% CI: 0.64-0.75), respectively. High RDW was identified as an independent prognostic factor for overall survival [hazard ratio (HR)=2.29; 95% CI: 1.3-4.01; P=0.004) but not for recurrence-free survival (HR=1.70; 95% CI: 0.93-3.12; P=0.085) by univariate and multivariate analysis. A high preoperative RDW was an independent predictor of poor prognosis in patients who had undergone radical resection of NSCLC. Therefore, patients with high RDW should be carefully monitored postoperatively, regardless of the disease stage.

Preoperatively elevated RDW-SD and RDW-CV predict favorable survival in intrahepatic cholangiocarcinoma patients after curative resection

BACKGROUND

Recent studies suggest red blood cell distribution width (RDW) was a prognostic factor in various types of cancer patients, although the results are controversial. The objective of this study was to investigate the significance of RDW in patients with intrahepatic cholangiocarcinoma (ICC) after radical resection.

METHOD

The relationship between the preoperative serum RDW value and clinic pathological characteristics was analyzed in 157 ICC patients between January 2012 and June 2018 who underwent curative resection. X-tile software was used to determine 40.2 fl, 12.6% as the optimal cut-off value for RDW-SD and RDW-CV respectively. 153 patients were classified into the low RDW-SD (≤ 40.2, n = 53) group and the high RDW-SD (> 40.2, n = 104) group, low RDW-CV (≤ 12.6, n = 94) group and the high RDW-CV (> 12.6, n = 63). Based on the RDW-SD combined with RDW-CV (SCC), classified into SCC = 0, 1 and 2 group. Kaplan-Meier survival analysis and Cox proportional hazard models were used to examine the effect of RDW on survival.

RESULTS

Kaplan-Meier curve analysis showed that Patients with RDW-SD > 40.2 were significantly associated with better OS (P = 0.004, median OS: 68.0 months versus 17.0 months). Patients with RDW-CV > 12.6 were significantly associated with better OS (p = 0.030, median OS: not reach versus 22.0 months). Compared with a SCC = 0 or SCC = 1, SCC = 2 was significantly associated with better OS (p < 0.001, median OS: not reach versus 33.0 months versus 16, respectively). In the multivariate analysis, RDW-SD > 40.2 fl (HR = 0.446, 95% CI: 0.262-0.760, p = 0.003), RDW-CV > 12.6% (HR = 0.425, 95%CI: 0.230-0.783, p = 0.006), SCC = 2 (HR = 0.270, 95%CI: 0.133-0.549, p < 0.001) were associated with favorable OS. The multivariate analysis showed RDW-SD, RDW-CV and SCC level were not independent prognostic factors for DFS.

CONCLUSIONS

Preoperative low levels of RDW are associated with poor survival in ICC after curative resection. This provides a new way for predicting the prognosis of ICC patients and more targeted intervention measures.

Prognostic significance of red blood cell distribution width in gastrointestinal cancers: A meta-analysis

BACKGROUND

Many publications showed red blood cell distribution width (RDW) might associate with the prognosis of gastrointestinal (GI) cancers, however, the agreement has not been reached because of controversial results. This meta-analysis aimed to explore the prognostic value of RDW in GI cancers.

METHODS

Four common databases were comprehensively searched to look for relevant studies. The meta-analyses for overall survival (OS) and disease-free survival were performed using hazard ratio (HR) and 95% confidence interval (CI), and the meta-analyses for clinical parameters were conducted using odd ratio and 95% CI.

RESULTS

A total of 13 studies involving with 3,509 patients with GI cancers were included into this study. The results showed, compared to patients with low RDW, patients with high RDW tended to have shorter OS (HR = 1.75, 95%CI = 1.57-1.94, P < .01) and disease-free survival (HR = 1.67, 95%CI = 1.39-2.00, P < .01). High RDW was associated with larger tumor size (P < .01), worse differentiation (P = .02), deeper invasion (P < .01), earlier lymph node metastasis (P < .01), more advanced clinical stage (P < .01) and higher carcinoembryonic antigen level (P < .01) when compared to low RDW.

CONCLUSION

High RDW was significantly associated with worse prognosis of GI cancers, which could be regarded as a prognostic biomarker for GI cancers. More prospective studies with large sample size and long follow-up period should be carried out to determine the prognostic significance of RDW in GI cancers in future.

Prognostic value of an inflammatory biomarker-based clinical algorithm in septic patients in the emergency department: An observational study

BACKGROUND

To develop an inflammatory biomarker-based, simple-to-use nomogram for the early identification of septic patients at high risk of mortality in the emergency department (ED).

METHODS

All patients diagnosed with sepsis admitted to the intensive care unit (ICU) from the ED were screened from the Medical Information Mart for Intensive Care III database and divided into two cohorts: the primary cohort and the validation cohort. We used bivariate logistic regression analysis to determine independent risk factors and to construct a predictive nomogram and subsequently evaluated the calibration, discrimination and clinical usefulness of the nomogram. The gradient boosting machine (GBM) model was used to more accurately evaluate these variables.

RESULTS

A total of 5663 admissions were enrolled, of which 3964 comprised the primary cohort and 1699 comprised the validation group, with 28-day mortality rates of 21.2% and 20.4%, respectively. Age > 69, neutrophil-to-lymphocyte ratio (NLR) > 9.8, platelet-to-lymphocyte ratio (PLR) > 249.89, lymphocyte-to-monocyte ratio (LMR) ≤ 2.18, and red cell distribution width (RDW) were detected as important determinants of 28-day mortality and included in the nomogram. The calibration plot revealed an adequate fit of the nomogram for predicting the risk of 28-day mortality. Regarding discriminative ability, receiver operating characteristic curve analysis showed that the nomogram had an area under the curve (AUC) of 0.826 (95% CI: 0.811-0.841, P < 0.001) in the primary cohort, which was greater than that of all individual parameters and other scores. Decision curve analysis also indicated that our nomogram was feasible in clinical practice, as the threshold probabilities were 0-0.62 for the primary cohort. The GBM model yielded a significantly greater AUC of up to 0.867.

CONCLUSIONS

This proposed simple-to-use nomogram based on age, NLR, PLR, LMR and RDW provides a relatively accurate mortality prediction for septic patients in the ED.

Clinical significance of an increased red blood cell distribution width in patients with rectal cancer undergoing chemoradiotherapy followed by surgery

PURPOSE

The clinical significance of the red blood cell distribution width (RDW) in patients with rectal cancer undergoing preoperative chemoradiotherapy (CRT) followed by surgery has not been fully evaluated.

METHODS

In this retrospective study, we investigated the association between the RDW and the prognosis in 120 patients with locally advanced rectal cancer (LARC). We also performed a subgroup analysis limited to patients with pathological TNM stage I-II (ypN[-]) LARC.

RESULTS

The RDW standard deviation was used to evaluate the RDW. We set 47.1% as the cut-off value of the RDW for the assessment of the prognosis. The RDW exhibited a significant negative relationship with the serum hemoglobin and albumin levels. An elevated RDW was an independent prognostic factor for the overall survival (OS) and disease-free survival (DFS) in patients with LARC. In addition, an elevated RDW predicted a poor OS and DFS in patients with pathological TNM stage I-II (ypN[-]) LARC.

CONCLUSIONS

The RDW is a promising predictor of a poor survival and recurrence in patients with LARC treated by CRT.

Red blood cell distribution width and platelet counts are independent prognostic factors and improve the predictive ability of IPI score in diffuse large B-cell lymphoma patients

Background

Elevated red blood cell distribution width (RDW) and decreased platelet count (PLT) can be clinically relevant to the prognosis in cancer patients. However, their prognostic values in patients with diffuse large B-cell lymphoma (DLBCL) need to be further explored.

Methods

Healthy donors (n = 130) and patients with DLBCL (n = 349) were included and evaluated retrospectively in this study. The prognostic influence of clinical and pathological factors including RDW and PLT on overall survival (OS) and progression-free survival (PFS) were studied by Kaplan-Meier curves. To evaluate the independent prognostic relevance of RDW and PLT, univariate and multivariate Cox proportional hazards regression models were applied. The adjusted IPI model was established based on the results of multivariate analysis, and verified by Harrell’s C statistical analysis.

Results

Kaplan-Meier curves indicated that an elevated RDW value and thrombocytopenia are poor factors for OS (P < 0.001, P = 0.006) and PFS (P = 0.003, P < 0.001) in DLBCL patients. Multivariate analysis confirmed that elevated RDW value (HR = 2.026, 95%CI = 1.263–3.250, P = 0.003) and decreased PLT count (HR =1.749, 95%CI = 1.010–3.028, P = 0.046) were both independent prognostic factors. The c-index of IPI and NCCN-IPI were increased when RDW level and PLT were supplemented in our cohort.

Conclusions

Our study shows that elevated RDW level and decreased PLT are independent poor prognostic factors in newly diagnosed DLBCL patients. Adding RDW and PLT to the IPI score may improve its predictive ability, and the adjusted IPI may be more powerful in predicting the survival of DLBCL patients in the rituximab era.

Prognostic role of pretreatment red blood cell distribution width in patients with cancer: A meta-analysis of 49 studies

Red blood cell distribution width (RDW) has been recently demonstrated to be a predictor of inflammation. High pretreatment RDW level is associated with poor survival outcomes in various malignancies, although the results are controversial. We aimed to investigate the prognostic role of RDW. A systematic literature search was performed in MEDLINE and EMBASE till April 2018. Pooled hazard ratios (HRs) were estimated for overall survival (OS) and combined disease-free survival, progression-free survival, and recurrence-free survival (DFS/PFS/RFS). 49 studies with 19,790 individuals were included in the final analysis. High RDW level adversely affected both OS and DFS/PFS/RFS. For solid cancers, colorectal cancer (CRC) had the strongest relationship with poor OS, followed by hepatic cancer (HCC). Negative OS outcomes were also observed in hematological malignancies. Furthermore, patients at either early or advanced stage had inverse relationship between high pretreatment RDW and poor OS. Studies with cut-off values between 13% and 14% had worse HRs for OS and DFS/PFS/RFS than others. Furthermore, region under the curve (ROC) analysis was used widely to define cut-off values and had relatively closer relationship with poorer HRs. In conclusion, our results suggested that elevated pretreatment RDW level could be a negative predictor for cancer prognosis.

Associations of lymphocyte percentage and red blood cell distribution width with risk of lung cancer

Objective

There is ample evidence to indicate that inflammation is involved in tumorigenesis. Lymphocyte percentage (LYM%) and red blood cell distribution width (RDW) are easily measured indicators of systemic inflammation. This study aimed to investigate the associations between LYM% and RDW and the risk of lung cancer.

Methods

We retrospectively reviewed the records of 430 patients with lung cancer and 158 healthy individuals (control group). Twenty clinical characteristics were analyzed, including LYM% and RDW. Significant laboratory indices were determined by univariate analysis and logistic regression was conducted to identify independent predictors of lung cancer risk.

Results

Patients with lung cancer had significantly lower LYM% and higher RDW levels compared with healthy controls. LYM% and RDW were confirmed to be independent predictors of lung cancer risk. LYM% also differed significantly among different histological subtypes of lung cancer.

Conclusion

A high risk of lung cancer was closely correlated with low LYM% and high RDW. LYM% and RDW are easily measured and may therefore aid the assessment and timely screening of lung cancer risk.

The potential value of red blood cell distribution width in patients with invasive hydatidiform mole

Background

Red blood cell distribution width (RDW) has attracted increasing attention in cancer. The aim of this study was to assess the changes of RDW in patients with invasive hydatidiform mole and analyze the relationship between RDW and invasive hydatidiform mole.

Methods

A retrospective analysis was performed on 102 patients diagnosed as invasive hydatidiform mole in the First Affiliated Hospital of Guangxi Medical University from January 2009 to March 2018. A total of 120 healthy subjects were used as a control group. The Mann‐Whitney U test was used for comparison between the invasive hydatidiform mole and control groups. Comparison of RDW with other blood parameters was performed using Spearman's. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) were also determined.

Results

The RDW, platelet‐lymphocyte ratio (PLR), neutrophil‐lymphocyte ratio (NLR), and absolute lymphocyte count were significantly elevated in the invasive hydatidiform mole group compared with control group. The hemoglobin (Hb) concentration, mean red blood cell volume (MCV) and platelet count (PLT) were significantly lower in invasive hydatidiform mole group than control group. Grade III and above invasive hydatidiform mole patients had higher levels of RDW than grade I and II patients. Correlation analysis showed that RDW was negatively correlated with Hb, MCV, NLR, and neutrophil count, but positively correlated with PDW and different stages of invasive hydatidiform mole. The ROC curve showed that the AUC of the RDW was 0.660 (95% CI 0.581‐0.740; P < 0.01).

Conclusion

This study reveals the potential value of RDW in invasive hydatidiform mole.

Comparison of non-invasive models for predicting liver damage in chronic hepatitis B patients

INTRODUCTION

Inexpensive blood tests have been well established as alternatives to liver biopsies to evaluate liver fibrosis in CHB patients. Here, we aim to compare their diagnostic accuracy in assessing liver fibrosis and necroinflammation.

PATIENTS AND METHODS

A retrospective study was performed to evaluate the predictive value of non-invasive models in chronic hepatitis B patients with liver fibrosis by the area under receiver operating characteristic curve (AUROC). The clinical data of 160 patients were collected from medical records.

RESULTS

Of the 160 consecutive treatment-naïve CHB patients, 29 (16%) had significant fibrosis and 34 (21%) had severe necroinflammation. The AUROC of the gamma-glutamyl transpeptidase to platelet ratio (GPR) (0.761, 95% CI 0.671-0.850) for predicting significant fibrosis was significantly higher than that of the aspartate transaminase-to-platelet ratio index (APRI) (0.680, 95% CI 0.585-0.774, p=0.034), but comparable with the fibrosis index based on four factors (Fib-4) (0.746, 95% CI 0.656-0.836, p=0.703), while for predicting severe necroinflammation, the performance of the GPR (AUROC=0.869, 95% CI 0.800-0.937) was better than the APRI (AUROC=0.816, 95% CI 0.740-0.892, p=0.085) and Fib-4 (0.792, 95% CI 0.711-0.873, p=0.023).

DISCUSSION

GPR is a satisfactory model to stage liver fibrosis and to grade necroinflammation activity, representing a convenient non-invasive alternative to liver biopsy in China.

Red Cell Distribution Width After Subarachnoid Hemorrhage

BACKGROUND

High red cell distribution width (RDW) values have been associated with increased hospital mortality in critically ill patients, but few data are available for subarachnoid hemorrhage (SAH).

METHODS

We analyzed an institutional database of adult (>18 y) patients admitted to the Department of Intensive Care after nontraumatic SAH between January 2011 and May 2016. RDW (normal value, 10.9% to 13.4%) was obtained daily from admission for a maximum of 7 days, from routine blood analysis. We recorded the occurrence of delayed cerebral ischemia (DCI), and neurological outcome (assessed using the Glasgow Outcome Scale [GOS]) at 3 months.

RESULTS

A total of 270 patients were included (median age 54 y-121/270 male [45%]), of whom 96 (36%) developed DCI and 109 (40%) had an unfavorable neurological outcome (GOS, 1 to 3). The median RDW on admission was 13.8 [13.3 to 14.5]% and the highest value during the intensive care unit (ICU) stay 14.2 [13.6 to 14.8]%. The RDW was high (>13.4%) in 177 patients (66%) on admission and in 217 (80%) at any time during the ICU stay. Patients with a high RDW on admission were more likely to have an unfavorable neurological outcome. In multivariable regression analysis, older age, a high WFNS grade on admission, presence of DCI or intracranial hypertension, previous neurological disease, vasopressor therapy and a high RDW (OR, 1.1618 [95% CI, 1.213-2.158]; P=0.001) during the ICU stay were independent predictors of unfavorable neurological outcome.

CONCLUSIONS

High RDW values were more likely to result in an unfavorable outcome after SAH. This information could help in the stratification of SAH patients already on ICU admission.

Prognostic role of neutrophil-lymphocyte ratio in esophageal cancer: A systematic review and meta-analysis

BACKGROUND

The prognostic role of neutrophil-to-lymphocyte ratio (NLR) in esophageal cancer (EC) remains controversial.

METHODS

The aim of this study was to evaluate the association between NLR and oncologic outcome of EC patients through a meta-analysis. A systematic search was performed in PubMed, Web of Science and Embase for relevant studies. Meta-analysis was performed using hazard ratio (HR) and95% confidence interval (CI) as effect measures.

RESULTS

Finally, 33 articles with 11,039patients were included in our study. The synthesized results indicated that the elevated NLR was negatively related to overall survival (OS) (HR = 1.39, 95% CI: 1.23-1.54). When the patients were stratified according to country, pathological type, treatment strategies, sample size, and different HR estimate method, high NLR was also significantly correlated with poor OS. Similarly, elevated NLR was also associated with shorter disease-free survival (DFS), progress-free survival (PFS), relapse-free survival (RFS), and cancer-specific survival (CSS).

CONCLUSION

The elevated pretreatment NLR is associated with poor oncological outcomes in patients with EC. NLR may be a significant predictive biomarker in EC. Further large-cohort studies are needed to confirm these findings.

Elevated red blood cell distribution width predicts poor prognosis in patients with oral squamous cell carcinoma

Introduction

Although red blood cell distribution width (RDW) has been reported to reflect inflammation and nutritional status and to predict prognosis in several different types of cancer, little is known about how RDW might be related to oral squamous cell carcinoma (OSCC). The present study aimed to investigate the prognostic value of preoperative RDW in OSCC patients.

Materials and methods

We included 236 OSCC patients from Jinan Stomatological Hospital (Shandong, People’s Republic of China) in this retrospective study. All enrolled patients were divided into 2 groups: high RDW (≥15%) and low RDW (<15%) according to the detected RDW values. The correlation of RDW and clinical characteristics was explored, and the prognostic significance of RDW evaluated using Kaplan–Meier curves, log-rank analysis, and the Cox proportional hazards model.

Results

The pretreatment median RDW among all OSCC patients was 14.4%, with a range from 11.6% to 24.5%. The RDW was found to be significantly correlated with node metastasis, tumor length, and TNM stage (P<0.05 for all). As for biochemical parameters, the results showed that higher RDW values were significantly associated with hemoglobin, mean corpuscular volume, white blood cell count, albumin, and C-reactive protein (P<0.01 for all). A significant association of RDW with the tumor marker cytokeratin 19 fragments (CYFRA21-1) and squamous cell carcinoma antigen (SCC-Ag) was also observed (P=0.02, and P=0.03; respectively). Moreover, patients with higher RDW were more likely to receive postoperative therapy (P=0.02). Kaplan–Meier survival curves showed that a high RDW was significantly associated with poor overall survival (OS) (P<0.01), especially in the early stages (I–II). Multivariate analysis revealed that an elevated RDW at diagnosis was an independent prognostic factor for shorter OS (HR =1.46, 95% CI: 1.13–2.86) after adjustment for other cancer-related prognostic factors.

Conclusion

These data suggest that an elevated preoperative RDW (≥15%) at diagnosis may independently predict poorer OS in patients with OSCC, but better-designed studies in the future should be performed to further confirm the value of monitoring RDW.

A prospective cohort examination of haematological parameters in relation to cancer death and incidence: the Busselton Health Study

BACKGROUND

Cancer risk is associated with serum iron levels. The aim of this study was to evaluate whether haematological parameters reflect serum iron levels and may also be associated with cancer risk.

METHODS

We studied 1564 men and 1769 women who were enrolled in the Busselton Health Study, Western Australia. Haematological parameters evaluated included haemoglobin (Hb), mean cell volume (MCV), mean cell haemoglobin (MCH) and mean cell haemoglobin concentration (MCHC) and red cell distribution width (RCDW). Statistical analyses included t-tests for quantitative variables, chi-square tests for categorical variables and Cox proportional hazards regression modelling for cancer incidence and death.

RESULTS

There was marginal evidence of an association between MCV (as a continuous variable) and non-skin cancer incidence in women (HR 1.15, 95% CI 1.013, 1.302; p = 0.030) but the hazard ratio was attenuated to non-significance after adjustment for serum ferritin (SF), iron and transferrin saturation (TS) (HR 1.11, 95% CI 0.972, 1.264; p = 0.126). There was strong evidence of an association between MCHC and prostate cancer incidence in men; the estimated hazard ratio for an increase of one SD (0.5) in MCHC was 1.27 (95% CI 1.064, 1.507; p = 0.008). These results remained significant after further adjustment for SF and iron; the estimated hazard ratio for an increase of one SD (0.5) in MCHC was 1.25 (p = 0.014, 95% CI 1.05 to 1.48).

CONCLUSIONS

The MCHC and MCV were associated with cancer incidence in a Western Australian population, although only MCHC remained associated with prostate cancer after adjusting with serum iron and TS (circulating iron) and SF (storage iron). Haematological parameters are thus of limited utility in population profiling for future cancer risk.

The red cell distribution width as a prognostic indicator in upper aerodigestive tract (UADT) cancer: A systematic review and meta-analysis

PURPOSE

The aim of this systematic review and meta-analysis was to investigate the relationship between the Red Cell Distribution Width (RDW) and prognosis in upper aerodigestive tract (UADT) cancer.

METHODS

PubMed (via the web), Embase, Scopus, and the Cochrane Library were searched. A systematic review and meta-analysis was done to generate the pooled hazard ratios (HR) for overall survival (OS), disease specific survival (DSS), and recurrence free survival (RFS).

RESULTS

Our analysis included the results of 4200 patients in 8 cohorts. The pooled data demonstrated that an elevated RDW was associated with significantly poorer OS (HR: 1.44, 95% CI: 1.13-1.83), RFS (HR: 1.43, 95%CI: 1.13-1.82). The DSS result had high heterogeneity and 95% CI was not pooled.

CONCLUSIONS

An elevated RDW may be an indicator of poor prognosis in UADT cancers in certain populations. Further research is needed to confirm this effect.

The Novel Prognostic Score Combining Red Blood Cell Distribution Width and Body Mass Index (COR-BMI) Has Prognostic Impact for Survival Outcomes in Nasopharyngeal Carcinoma

Background: A novel inflammation-and nutrition-based scoring system based on red blood cell distribution width and body mass index (COR-BMI) has prognostic value in nasopharyngeal carcinoma (NPC). Here, we assessed the prognostic value of COR-BMI in NPC.

Methods: Retrospective study of 2,318 patients with non-metastatic NPC treated at Sun Yat-sen University Cancer Center was conducted. Patients were stratified into three groups using the COR-BMI score, which is based on two objective and easily measurable parameters: red blood cell distribution width (RDW) and body mass index (BMI). Kaplan-Meier survival analyses were used to compare groups; multivariate Cox proportional models were used to calculate overall survival (OS) and disease-free survival (DFS).

Results: Four-year overall survival (OS) rates were 88.7%, 84.5%, and 71.4% for patients with COR-BMI scores of 0, 1, and 2 respectively (P = 0.006). Multivariate Cox proportional hazard analysis revealed COR-BMI was an independent predictor of OS (HR for COR-BMI 1: 1.239, 95% CI: 1.012-1.590; HR for COR-BMI 2: 2.367, 95% CI: 1.311-4.274, P = 0.013), but not DFS (P = 0.482). In subgroup analysis of metastatic NPC, OS rates decreased as COR-BMI increased. In patients with a COR-BMI score of 1, radiotherapy plus chemotherapy led to better OS than radiotherapy alone.

Conclusions: COR-BMI may serve as an indicator of poor prognosis in both NPC and metastatic NPC. Radiotherapy plus chemotherapy may benefit patients with a COR-BMI score of 1.

Prognostic impact of the red cell distribution width in esophageal cancer patients: A systematic review and meta-analysis

AIM

To clarify the previous discrepant conclusions, we performed a meta-analysis to evaluate the prognostic value of red cell distribution width (RDW) in esophageal cancer (EC).

METHODS

We searched the PubMed, EMBASE, Web of Science and Cochrane Library databases to identify clinical studies, followed by using STATA version 12.0 for statistical analysis. Studies that met the following criteria were considered eligible: (1) Studies including EC patients who underwent radical esophagectomy; (2) studies including patients with localized disease without distant metastasis; (3) studies including patients without preoperative neoadjuvant therapy; (4) studies including patients without previous antiinflammatory therapies and with available preoperative laboratory outcomes; (5) studies reporting association between the preoperative RDW and overall survival (OS)/disease-free survival (DFS)/cancer-specific survival (CSS); and (6) studies published in English.

RESULTS

A total of six articles, published between 2015 and 2017, fulfilled the selection criteria in the end. Statistical analysis showed that RDW was not associated with the prognosis of EC patients, irrespective of OS/CSS [hazard ratio (HR) = 1.27, 95% confidence interval (CI): 0.97-1.57, P = 0.000] or DFS (HR = 1.42, 95%CI: 0.96-1.88, P = 0.000). Subgroup analysis indicated that elevated RDW was significantly associated with worse OS/CSS of EC patients when RDW > 13% (HR = 1.45, 95%CI: 1.13-1.76, P = 0.000), when the patient number ≤ 400 (HR = 1.45, 95%CI: 1.13-1.76, P = 0.000) and when the study type was retrospective (HR = 1.42, 95%CI : 1.16-1.69, P = 0.000).

CONCLUSION

Contrary to our general understanding, this meta-analysis revealed that RDW cannot serve as an indicator of poor prognosis in patients with EC. However, it may still be a useful predictor of unfavorable prognosis using an appropriate cut-off value.

Prognostic value of platelet-to-lymphocyte ratio in oncologic outcomes of esophageal cancer: A systematic review and meta-analysis

The platelet-to-lymphocyte ratio (PLR) is a useful prognostic factor in several cancers. However, the prognostic role of PLR in esophageal cancer remains controversial. The aim of this study is to evaluate the association between PLR and the oncologic outcome of esophageal cancer patients through a meta-analysis. Relevant articles were researched from Embase, PubMed, and Web of Science databases. The meta-analysis was performed using hazard ratio (HR) and 95% confidence intervals (CIs) as effect measures. Finally, 19 articles with 6134 patients were included in our study. The summary results indicated that the elevated PLR was negatively related to overall survival (HR= 1.263; 95% CI 1.094, 1.458). The subgroup analysis revealed that increased PLR was associated with poor overall survival in esophageal cancer patients for Asians (HR=1.252; 95% CI 1.141, 1.373) but not for Caucasians (HR=1.463; 95% CI 0.611, 3.502). When the patients were segregated by pathological type, sample size, and HR estimate method, high PLR was also significantly correlated with poor overall survival. In contrast, elevated PLR was not statistically associated with disease-free survival or cancer-specific survival. High PLR is associated with poor overall survival in patients with esophageal cancer. PLR may be a significant predictive biomarker in patients with esophageal cancer. Further large-cohort studies are needed to confirm these findings.

Pre-treatment red blood cell distribution width provides prognostic information in multiple myeloma

BACKGROUND

The red blood cell distribution width (RDW), a credible marker for abnormal erythropoiesis, has recently been studied as a prognostic factor in oncology, but its role in multiple myeloma (MM) hasn't been thoroughly investigated.

METHODS

We performed a retrospective study in 162 patients with multiple myeloma. Categorical parameters were analyzed using Pearson chi-squared test. The Mann-Whitney and Wilcoxon tests were used for group comparisons. Comparisons of repeated samples data were analyzed with the general linear model repeated-measures procedure. The Kaplan-Meier product-limit method was used to determine OS and PFS, and the differences were assessed by the log-rank test.

RESULTS

High RDW baseline was significantly associated with indexes including haemoglobin, bone marrow plasma cell infiltration, and cytogenetics risk stratification. After chemotherapy, the overall response rate (ORR) decreased as RDW baseline increased. In 24 patients with high RDW baseline, it was revealed RDW value decreased when patients achieved complete remission (CR), but increased when the disease progressed. The normal-RDW baseline group showed both longer overall survival (OS) and progression-free survival (PFS) than the high-RDW baseline group.

CONCLUSION

Our study suggests pre-treatment RDW level is a prognostic factor in MM and should be regarded as an important parameter for assessment of therapeutic efficiency.

Prognostic significance of red blood cell distribution width in gastrointestinal disorders

The red blood cell distribution width (RDW) is a routinely measured and automatically reported blood parameter, which reflects the degree of anisocytosis. Recently, the baseline RDW was found to have clinical significance for assessing clinical outcome and severity of various pathological conditions including cardiovascular diseases, sepsis, cancers, leukemia, renal dysfunction and respiratory diseases. A myriad of factors, most of which ill-defined, have an impact on the red cell population dynamics (i.e., production, maturation and turnover). A delay in the red blood cell clearance in pathological conditions represents one of the leading determinants of increased anisocytosis. Further study of RDW may reveal new insight into inflammation mechanisms. In this review, we specifically discuss the current literature about the association of RDW in various disease conditions involving the gastrointestinal and hepatobiliary systems. We also present some of the related measurements for their value in predicting clinical outcomes in such conditions. According to our data, RDW was found to be a valuable prognostic index in gastrointestinal disorders along with additional inflammatory biomarkers (i.e., C reactive protein, erythrocyte sedimentation rate, and platelet count) and current disease severity indices used in clinical practice.

Significance of Pretreatment Red Blood Cell Distribution Width in Patients with Newly Diagnosed Glioblastoma

BACKGROUND Red blood cell distribution width (RDW) is a parameter of the complete blood count (CBC) test. Recent evidence suggests that pretreatment RDW is associated with patient survival in various malignant tumors. We explored the association of pretreatment RDW and other red blood cell (RBC) parameters with clinical parameters and assessed their prognostic impact on overall survival (OS) in patients with glioblastoma (GBM). MATERIAL AND METHODS In total, 109 patients with newly diagnosed GBM were retrospectively reviewed. The Cox proportional hazards regression model and Kaplan-Meier method were used to examine the survival function of pretreatment RDW, mean cell volume (MCV), hemoglobin (HGB), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), RBC count, and hematocrit (HCT) values in patients with newly diagnosed GBM. RESULTS Univariate analysis showed that MCV, MCHC, and RDW were associated with overall survival (OS). However, only RDW remained significant in multivariate analysis. The Kaplan-Meier survival curves showed that patients belonging to the high-RDW group had a worse median OS (293 days versus 375 days, P=0.023) than those belonging to the low-RDW group. CONCLUSIONS The present study showed that pretreatment RDW was superior to MCV and MCHC as a prognostic predictor of clinical outcome in patients newly diagnosed with GBM. Pretreatment RDW was derived directly from the CBC test, which can be easily performed in clinical practice. Therefore, pretreatment RDW values can provide additional prognostic information for patients with GBM. Further larger and prospective studies are needed to confirm these findings and to investigate the mechanism by which of RDW is associated with prognosis in patients with GBM.

Pretreatment Hematocrit Is Superior to Hemoglobin as a Prognostic Factor for Triple Negative Breast Cancer

BACKGROUND

Anemia usually refers to low hemoglobin (Hb) levels. Previous studies indicated that anemia negatively influence the survival in various cancers. Hematocrit (HCT) is the volume percentage of red blood cells in blood, which could indicate anemia in both individuals and populations. This study compared the value of HCT with that of Hb for predicting outcomes of patients who underwent treatment for triple negative breast cancer (TNBC).

METHODS

A retrospective study of 293 triple negative breast cancer patients, accepting treatment from January 2004 to December 2009 at Sun Yat-sen University Cancer Center, was conducted. Kaplan-Meier curves and multivariate Cox proportional models were used to calculate disease free survival (DFS) and overall survival (OS).

RESULTS

The cut-off value of HCT was 35.9% determined by X-tile software analysis. The cut-off value of Hb was 12.0 g/dl based on the World Health Organization (WHO) criteria. In univariate analysis, low HCT and low Hb were both significantly associated with decreased DFS and OS. In multivariate analysis, HCT (HR: 0.570; 95% CI: 0.331-0.981, P = 0.042 for DFS; HR: 0.456; 95% CI: 0.256-0.813, P = 0.008 for OS) was still identified as independent predictor of outcome, but not Hb.

CONCLUSION

Pretreatment low HCT is independently associated with poor prognosis in TNBC patients. However, HCT was found to be superior to Hb in terms of predicting breast cancer mortality. In the future, large-scale prospective studies or validation studies are needed to verify our findings.

Red cell distribution width and cancer

Red cell distribution width (RDW) is an index which primarily reflects impaired erythropoiesis and abnormal red blood cell survival. In last years the interest in this marker has considerably grown and now a lot of data are available indicating that this simple and inexpensive parameter is a strong and independent risk factor for death in the general population. Moreover, several investigations have been performed to investigate the role of RDW in cardiovascular and thrombotic disorders. Contrarily, there are relatively few reports focusing on RDW in the area of oncology and to date none review have been performed in this specific field. As such, the aim of this narrative review is to summarize some interesting results obtained in studies performed in patients affected by solid and hematological tumors. Even if larger studies are needed before these preliminary findings can be generalized, it seems plausible to affirm that RDW can be useful by adding prognostic information in patients with oncologic disease.