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Staniewska E, Grudzien K, Stankiewicz M, Raczek-Zwierzycka K, Rembak-Szynkiewicz J, Nowicka Z, Tarnawski R, Miszczyk M. The Prognostic Value of the Systemic Immune-Inflammation Index (SII) and Red Cell Distribution Width (RDW) in Patients with Cervical Cancer Treated Using Radiotherapy. Cancers (Basel) 2024; 16:1542. [PMID: 38672624 PMCID: PMC11049631 DOI: 10.3390/cancers16081542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/04/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION There is growing interest in the prognostic value of routinely performed pre-treatment blood test indices, such as the RDW or SII, with the latter combining the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). These indices were shown to be prognostic for survival in some malignancies. The purpose of this study was to evaluate the association between pre-treatment RDW and SII, and OS in patients treated with radiotherapy for primary localised cervical cancer. MATERIAL AND METHODS This retrospective analysis included patients treated with definitive CRT between 2011 and 2017 for histopathologically confirmed FIGO 2018 stage IB2-IVA cervical cancer. Statistical analysis was performed using the Kaplan-Meier method, two-sided log-rank tests, and Cox proportional hazards models, with the AIC serving as a prediction error estimator. RESULTS The study group included 249 patients with a median age of 57.2 years and a median follow-up of 75.8 months. The majority were diagnosed with squamous cell carcinoma (237; 95.2%) and had FIGO stage III (211; 84.7%). Approximately half of the patients (116; 46.4%) had regional lymph node metastases. Patients with a low RDW (≤13.4%) and low SII (≤986.01) had a significantly longer OS (p = 0.001 and p = 0.002). The RDW remained as an independent prognostic factor in the multivariable model (high vs. low; HR = 2.04; 95% CI: 1.32-3.16; p = 0.001). Including RDW in the model decreased the Akaike Information Criterion from 1028.25 to 1018.15. CONCLUSIONS The RDW is a cheap and widely available index that is simultaneously an independent prognostic factor for survival and could be used to improve pre-treatment prognosis assessments in patients with cervical cancer undergoing CRT. Available data encourage assessing the RDW as a prognostic factor in prospective trials to aid the identification of candidates for treatment escalation.
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Affiliation(s)
- Emilia Staniewska
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
| | - Karolina Grudzien
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
| | - Magdalena Stankiewicz
- Brachytherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
| | - Katarzyna Raczek-Zwierzycka
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
| | - Justyna Rembak-Szynkiewicz
- Radiology and Diagnostic Imaging Department, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
| | - Zuzanna Nowicka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 90-419 Lodz, Poland
| | - Rafal Tarnawski
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
| | - Marcin Miszczyk
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Collegium Medicum—Faculty of Medicine, WSB University, 41-300 Dąbrowa Górnicza, Poland
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Trevisani LFM, Kulcsar IF, Kulcsar MAV, Dedivitis RA, Kowalski LP, Matos LL. Prognostic Value of Hematological Parameters in Oral Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:5245. [PMID: 37958419 PMCID: PMC10649982 DOI: 10.3390/cancers15215245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Oral squamous cell carcinoma (OSCC) remains a significant public health concern. The variables utilized to determine appropriate treatment for this disease also represent its most unfavorable prognostic factors, with these parameters solely determined by the neoplasm and its behavior. However, a lack of well-established indices is evident in the literature that specifically relate to the patient and indicate a worse prognosis. OBJECTIVE To assess the prognostic impact of hematological indices in patients with OSCC. METHODS This retrospective cohort study included patients with oral squamous cell carcinoma (OSCC) who underwent curative-intent treatment. Treatment encompassed surgery, followed by adjuvant therapy, as necessary. Laboratory tests were conducted immediately prior to surgery, and demographic information was obtained from medical records. RESULTS The cohort comprised 600 patients, with 73.5% being male subjects. Adjuvant treatment was recommended for 60.3% of patients. Throughout the follow-up period, 48.8% of participants died. Univariate analysis indicated that perineural invasion, angiolymphatic invasion, pT4 tumors, lymph node metastases, extranodal extravasation, RDW > 14.3%, NLR (neutrophil-lymphocyte ratio) > 3.38, PLR (platelet-lymphocyte ratio) > 167.3, and SII (systemic inflammatory/immune response index) > 416.1 were factors associated with increased mortality. These threshold values were established through ROC curve analysis. In the multivariate analysis, angiolymphatic invasion (HR = 1.43; 95% CI: 1.076-1.925; p = 0.014), pT4a/b tumors (HR = 1.761; 95% CI: 1.327-2.337; p < 0.001), extranodal extravasation (HR = 1.420; 95% CI: 1.047-1.926; p = 0.024), and RDW (HR = 1.541; 95% CI: 1.153-2.056; p = 0.003) were identified as independent risk factors for decreased overall survival. CONCLUSIONS RDW > 14.3% was proven to be a reliable parameter for assessing overall survival in patients with OSCC. Further studies are required to evaluate the clinical applicability of other hematological indices.
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Affiliation(s)
- Lorenzo Fernandes Moça Trevisani
- Programa de Pós-Graduação em Anestesiologia, Ciências Cirúrgicas e Medicina Perioperatória, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, Brazil;
| | - Isabelle Fernandes Kulcsar
- Instituto do Câncer do Estado de São Paulo (Icesp), Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-000, Brazil;
| | - Marco Aurélio Vamondes Kulcsar
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo (Icesp), Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-000, Brazil;
| | - Rogerio Aparecido Dedivitis
- Head and Neck Surgery Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-000, Brazil;
| | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-000, Brazil;
| | - Leandro Luongo Matos
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo (Icesp), Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-000, Brazil;
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo 05652-000, Brazil
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Eoh KJ, Lee TK, Nam EJ, Kim SW, Kim YT. Clinical Relevance of Red Blood Cell Distribution Width (RDW) in Endometrial Cancer: A Retrospective Single-Center Experience from Korea. Cancers (Basel) 2023; 15:3984. [PMID: 37568799 PMCID: PMC10417026 DOI: 10.3390/cancers15153984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Red blood cell distribution width (RDW) is a standard parameter of complete blood count and indicates the variability in red blood cell size. This study aimed to determine whether preoperative RDW can be used to predict the recurrence and prognosis of endometrial carcinoma. METHODS The medical records of 431 patients diagnosed with endometrial carcinoma were retrospectively reviewed between May 2006 and June 2018. In addition to RDW, the clinicopathological factors, survival curves, and prognoses of the patients with endometrial carcinoma were compared between the high (n = 213) and low (n = 218) groups according to the median RDW value (12.8%). RESULTS The patients with high RDW had significantly advanced-stage (p = 0.00) pelvic lymph node metastasis (p = 0.01) and recurrence (p = 0.01) compared to those in the low-RDW group. In univariate analysis with DFS as the endpoint, surgical stage, type II histology, grade, RDW, and lymph node metastasis were independently associated with survival. Patients with high RDW values had significantly shorter disease-free survival and overall survival than those with low RDW values (log-rank p = 0.03, log-rank p = 0.04, respectively). CONCLUSION Our results demonstrate that RDW is a simple and convenient indicator of endometrial carcinoma recurrence. Prospective studies are needed to validate the findings of the current study.
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Affiliation(s)
- Kyung-Jin Eoh
- Department of Obstetrics and Gynecology, Yongin Severance Hospital, College of Medicine, Yonsei University, Yongin 16995, Republic of Korea;
| | - Tae-Kyung Lee
- Department of Obstetrics and Gynecology, College of Medicine, Inha University, Incheon 22332, Republic of Korea;
| | - Eun-Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women’s Medical Life Science, Severance Hospital, College of Medicine, Yonsei University, Seoul 06273, Republic of Korea; (E.-J.N.); (S.-W.K.)
| | - Sang-Wun Kim
- Department of Obstetrics and Gynecology, Institute of Women’s Medical Life Science, Severance Hospital, College of Medicine, Yonsei University, Seoul 06273, Republic of Korea; (E.-J.N.); (S.-W.K.)
| | - Young-Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women’s Medical Life Science, Severance Hospital, College of Medicine, Yonsei University, Seoul 06273, Republic of Korea; (E.-J.N.); (S.-W.K.)
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Trevisani LFM, Kulcsar IF, Leite AKN, Kulcsar MAV, Lima GAS, Dedivitis RA, Kowalski LP, Matos LL. Nutritional and immunological parameters as prognostic factors in patients with advanced oral cancer. Braz J Otorhinolaryngol 2022; 88 Suppl 4:S89-S97. [PMID: 35277368 DOI: 10.1016/j.bjorl.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/05/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim of the present study was to analyze the prognostic relationship of weight loss and preoperative hematological indexes in patients surgically treated for pT4a squamous cell carcinoma of the oral cavity. METHODS A retrospective cohort study. RESULTS Percent weight loss greater than 10% was identified in 49 patients (28.2%), and any weight loss in relation to the usual weight occurred in 140 patients (78.7%). Percent weight loss greater than 10% (HR = 1.679), Red cell distribution width (RDW) values greater than 14.3% (HR = 2.210) and extracapsular spread (HR = 1.677) were independent variables associated with risk of death. CONCLUSION Patients with advanced squamous cell carcinoma of the oral cavity present significant weight loss and as significantly immunocompromised. Increased values of RDW and higher percentages of weight loss in relation to the individual's usual weight, together with extracapsular spread of metastatic lymph nodes, were risk factors for lower survival, regardless of other clinical and anatomopathological characteristics. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Lorenzo Fernandes Moça Trevisani
- Universidade de São Paulo, Faculdade de Medicina, Programa de Pós-Graduação em Anestesiologia, Ciências Cirúrgicas e Medicina Perioperatória, São Paulo, SP, Brazil
| | | | - Ana Kober Nogueira Leite
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (Icesp), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Marco Aurélio Vamondes Kulcsar
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (Icesp), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Graziele Aparecida Simões Lima
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
| | - Rogerio Aparecido Dedivitis
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Luiz Paulo Kowalski
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Leandro Luongo Matos
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil.
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Marcus K, Sullivan CB, Al-Qurayshi Z, Buchakjian MR. Can Red Blood Cell Distribution Width Predict Laryngectomy Complications or Survival Outcomes? Ann Otol Rhinol Laryngol 2022; 131:1102-1108. [PMID: 34715735 DOI: 10.1177/00034894211056117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Red blood cell distribution width (RDW), a reported biomarker for morbidity and mortality in chronic disease and following certain surgeries, has not been well-studied in head and neck cancer patients. The aim of the study was to examine the association of RDW with postoperative complications and survival among patients who underwent primary or salvage laryngectomy. METHODS We analyzed a retrospective case series study of patients diagnosed with squamous cell carcinoma of the larynx treated with total laryngectomy. Survival outcomes were examined using Kaplan-Meier analysis. RESULTS One hundred seventy-seven patients were included in the final analysis. The most common tumor subsite was the supraglottis (60%). On bivariate analysis, patients with RDW ≥14.5 had higher prevalence of non-surgical, systemic complications, including deep venous thrombosis, pneumonia, cardiovascular events, and difficulty weaning from mechanical ventilation. However, there was no significant difference in laryngectomy-specific post-operative complications, including pharyngocutaneous fistula, wound infection, stoma complications, and chyle leak. RDW was not found to be associated with survival outcomes following laryngectomy. CONCLUSIONS Among laryngectomy patients, RDW ≥14.5 is associated with higher prevalence of systemic morbidity, but not with specific local surgical complications or decreased survival.
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Affiliation(s)
- Kathryn Marcus
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Zaid Al-Qurayshi
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Marisa R Buchakjian
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Li Y, Li Z, Zhang G. Clinical Utility of Red Blood Cell Distribution Width for the Diagnosis and Prognosis of Cervical Cancer. Int J Gen Med 2022; 15:2597-2606. [PMID: 35282652 PMCID: PMC8910443 DOI: 10.2147/ijgm.s354569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/17/2022] [Indexed: 12/13/2022] Open
Abstract
Background The width of red blood cell distribution (RDW) is correlated with some diseases, but its clinical value and prognostic role in cervical cancer is unclear. Methods We used receiver operating characteristic curves to evaluate the diagnostic ability of RDW and other clinical parameters in cervical cancer based on a case–control design. Using retrospective data, we explored the correlation of RDW with overall (OS) and progression-free (PFS) survival using Kaplan–Meier analysis and univariate and multivariate Cox regression with the hazard ratio (HR) and 95% confidence interval (CI). A restricted cubic plot was used to evaluate the nonlinear association between RDW and prognosis risk. Results RDW was significantly higher in cases than in controls (14.6±1.7 vs 12.5±1.8, P<0.001). It showed high diagnostic accuracy for cervical cancer, with a sensitivity of 79.3%, specificity of 65.6%, and area under the curve of 0.802 (95% CI, 0.775–0.827) with a cutoff value of 13.88. There was a significant positive correlation between RDW and C-reactive protein (r=0.434, P=0.023). Multivariate Cox regression indicated that it was independently associated with a poorer PFS (HR, 2.05; 95% CI, 1.25–3.18, P<0.001) and OS (HR, 2.73; 95% CI, 1.61–4.64, P<0.001). RDW>14.66 showed a nonlinear increased risk for a poor PFS and OS. Conclusion RDW is an easy, quick, and inexpensive tool for the early detection and risk management of cervical cancer. A greater RDW is associated with a poor prognosis in cervical cancer.
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Affiliation(s)
- Yanyan Li
- Department of Nursing, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, People’s Republic of China
| | - Zhanzhan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, People’s Republic of China
| | - Guangying Zhang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, People’s Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, People’s Republic of China
- Correspondence: Guangying Zhang, Department of Oncology, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Kaifu District, Changsha, Hunan Province, 410008, People’s Republic of China, Email
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Prognostic value of red blood cell distribution width for mortality in patients with hypertrophic cardiomyopathy. Clin Biochem 2021; 96:19-25. [PMID: 34245695 DOI: 10.1016/j.clinbiochem.2021.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/15/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Red blood cell distribution width (RDW) has emerged as a useful indicator for adverse outcomes in several cardiovascular diseases. The relation between RDW and the prognosis of hypertrophic cardiomyopathy (HCM) remains to be evaluated. We examined the relation between RDW and all-cause mortality and HCM-related death in a population of adult HCM patients. METHODS We performed clinical evaluation in 414 consecutive adult HCM patients (median age, 57.5 years; male, 54.8%). RESULTS During a median follow-up of 3.7 years, all-cause mortality and HCM-related death occurred in 75 (18.1%) and 50 (12.1%) patients, respectively. Based on the tertiles of baseline RDW, mortality increased with higher tertile. With the tertile 1 as reference, adjusted all-cause mortality hazard ratios (HRs) were 3.9 for the tertile 2 (95% confidence interval [CI]: 1.5-10.3) and 3.1 for the tertile 3 (95% CI: 1.1-8.2). Adjusted HCM-related death HRs were higher in the tertile 2 (HR: 5.5; 95% CI: 1.2-24.4) and tertile 3 (HR: 6.6; 95% CI: 1.5-29.0) compared with the tertile 1. Further smooth curve fitting exhibited a saturation effect after adjusting for confounders, and there were a two-stage change and an inflection point. Two-piecewise Cox model suggested mortality significantly increased with RDW level up to the inflection point (about 14.0% for both all-cause mortality and HCM-related death), and RDW was not associated with mortality after the point. CONCLUSION In adult HCM patients, we found increased RDW was a significant risk predictor for all-cause mortality and HCM-related death, and a saturation effect was observed.
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Prognostic Value of the Red Cell Distribution Width in Patients with Sepsis-Induced Acute Respiratory Distress Syndrome: A Retrospective Cohort Study. DISEASE MARKERS 2021; 2021:5543822. [PMID: 34122669 PMCID: PMC8189810 DOI: 10.1155/2021/5543822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/07/2021] [Accepted: 05/23/2021] [Indexed: 12/19/2022]
Abstract
Objective The prognostic value of the red cell distribution width (RDW) in patients with sepsis-induced acute respiratory distress syndrome (ARDS) is still elusive. This study is aimed at determining whether RDW is a prognostic indicator of sepsis-induced ARDS. Methods This retrospective cohort study included 1161 patients with sepsis-induced ARDS. The datasets were acquired from the Medical Information Mart for Intensive Care III database. The locally weighted scatter-plot smoothing technique, Cox regression, Kaplan-Meier estimator, and subgroup analysis were carried out to evaluate the association between RDW and 90-day mortality. Results The RDW and mortality had a roughly linear increasing relationship. The Cox regression model results were as follows: for level 2 (14.5% < RDW < 16.2%), hazard ratio (HR) = 1.35, 95% confidence interval (CI) = 1.03–1.77, and for level 3 (RDW ≥ 16.2%), HR = 2.07, 95% CI = 1.59–2.69. The following results were obtained when RDW was treated as a continuous variable: HR = 1.11, 95%CI = 1.06–1.15. The P values of the interaction between the RDW and covariates were greater than 0.05. Conclusion RDW is a new independent prognostic marker for patients with sepsis-induced ARDS.
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Comment on "Clinical Importance of Mean Corpuscular Volume as a Prognostic Marker After Esophagectomy for Esophageal Cancer: A Retrospective Study". Ann Surg 2020; 274:e751-e752. [PMID: 33278163 DOI: 10.1097/sla.0000000000004158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Movahed S, Norouzy A, Ghanbari Motlagh A, Eslami S, Khadem-Rezaiyan M, Emadzadeh M, Nematy M, Ghayour-Mobarhan M, Varshoee Tabrizi F, Bozzetti F, Seilanian Toussi M. Nutritional Status in Patients with Esophageal Cancer Receiving Chemoradiation and Assessing the Efficacy of Usual Care for Nutritional Managements. Asian Pac J Cancer Prev 2020; 21:2315-2323. [PMID: 32856860 PMCID: PMC7771945 DOI: 10.31557/apjcp.2020.21.8.2315] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malnutrition is prevalent in esophageal cancer patients which affects cancer prognosis. The purpose of this study was a comprehensive assessment of nutritional status during Chemoradiation (CRT). METHODS Newly diagnosed adults with esophageal cancer were recruited for this study. Patient-Generated- Subjective Global Assessment (PG-SGA), anthropometric indices, body composition, dietary intake, laboratory tests, and nutritional-related complications were assessed before, after, and 4 to 6 weeks after CRT. RESULTS Seventy-one cases were enrolled. The mean age was 66.8±12 years. Patients' mean weight loss was 2.42±2.4 kilograms during treatment. A significant reduction observed in mean MUAC (26.68±4.9 vs. 25.42±5.1 cm), fat mass percentage (24.11±11.8 vs. 22.8±12.5), fat free mass index (16.87±2.4 vs. 16.47±2.6 kg/m2) and hand grip strength (43.2±19 vs. 36.1±20 kg) during CRT (all p-values <0.0001). We had also a non-significant change in mean energy intake (19.5±11 vs. 18.3±11 kcal/kgw. day) and protein intake (0.56±0.4 vs. 0.66±0.5 g/kgw.day) during CRT. In our assessment before, immediately after and 4-6 weeks following CRT, we recorded energy intake insufficiency in 55.7%, 58.7% and 27.3% and protein intake inadequacy in 89.8%, 89.1% and 72.7% of cases, respectively. The most common complications were dysphagia (56.7%), anorexia (25%), and constipation (47.9%) at admission. Dysphagia improved in some cases (42%), but anorexia (35%), early satiety (25%), Esophagitis (25%), dysosmia (21%) and dysgeusia (17%) were increased as CRT complication. yet, 25% of patients had dysphagia and 34.4% had constipation 4-6 weeks after CRT. The twelve-months mortality was significantly associated with lower BMI after CRT, primary PG-SGA score, weight loss, BMI<18.5, MUAC, physical performance, living in rural or urban areas, addiction. CONCLUSION Our study demonstrated a high prevalence of malnutrition among esophageal cancer patients which worsened during Chemoradiotherapy. Our findings warrant early screening and monitoring of nutritional status and effective nutritional interventions with symptoms management during treatment in these patients. .
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Affiliation(s)
- Sara Movahed
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Abdolreza Norouzy
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Majid Khadem-Rezaiyan
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Maryam Emadzadeh
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mohsen Nematy
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Majid Ghayour-Mobarhan
- Metabolic Syndrome Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Federico Bozzetti
- Department of surgery, Faculty of Medicine, University of Milan, Lombardia, Italy.
| | - Mehdi Seilanian Toussi
- Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Miszczyk M, Jabłońska I, Magrowski Ł, Masri O, Rajwa P. The association between RDW and survival of patients with squamous cell carcinoma of the tongue. Simple, cheap and convenient? Rep Pract Oncol Radiother 2020; 25:494-499. [PMID: 32477015 DOI: 10.1016/j.rpor.2020.03.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/28/2020] [Accepted: 03/30/2020] [Indexed: 12/30/2022] Open
Abstract
Aim The purpose of this study was to evaluate the prognostic impact of red-cell distribution width (RDW) on the overall survival (OS) of patients with squamous cell carcinoma (SCC) of the tongue. Background Development of cancer is connected with an ongoing inflammatory process which is reflected by laboratory indices, such as RDW that can be used as prognostic tools. Material and methods The study group consists of 74 consecutive patients treated with radical radiotherapy or chemo-radiotherapy for SSC of the tongue at one institution between 2005-2014. RDW was assessed based on routine blood tests done before the start of the treatment. ROC curve was applied to assess value of RDW in prediction of OS, and a cut-off value for further tests was obtained using the Younden index. The survival analysis was performed using the Kaplan-Meier method, log-rank testing and Cox regression model. Results The AUC for RDW in ROC analysis was 0.703, and the optimal cut-off value was 13.5%. 5-year OS was significantly lower in patients with RDW ≥ 13.5% compared with patients with RDW < 13.5% (67% vs. 26%, p-value = 0.0005). Additionally, high RDW was associated with a greater odds ratio for 5-year OS in a multivariate Cox proportional hazards regression analysis (3.43, 1.62-7.25; p = 0.001). Conclusion Our study demonstrated that pre-treatment RDW ≥ 13,5% is an indicator of poor overall survival in patients with SCC of the tongue. Since RDW is a cheap and convenient marker, usually routinely assessed during complete blood count tests, it could be further used as an additional prognostic tool in patients with tongue cancers.
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Affiliation(s)
- Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Clinic, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Iwona Jabłońska
- IIIrd Radiotherapy and Chemotherapy Clinic, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Łukasz Magrowski
- IIIrd Radiotherapy and Chemotherapy Clinic, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Oliwia Masri
- IIIrd Radiotherapy and Chemotherapy Clinic, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Paweł Rajwa
- Department of Urology, Medical University of Silesia, 3 Maja Street 13-15, 41-800 Zabrze, Poland
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12
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Ma W, Mao S, Bao M, Wu Y, Guo Y, Liu J, Wang R, Li C, Zhang J, Zhang W, Yao X. Prognostic significance of red cell distribution width in bladder cancer. Transl Androl Urol 2020; 9:295-302. [PMID: 32420135 PMCID: PMC7215002 DOI: 10.21037/tau.2020.03.08] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Bladder cancer is one of the most common cancers worldwide. It ranks ninth among all cancers and fourth among cancers in male patients. Recent studies reported that red blood cell (RBC) distribution width (RDW) was a potential predictor in some cancers. This study explored the significance of RDW in patients with bladder cancer after radical cystectomy. Methods This study involved 169 patients who underwent radical cystectomy between March 2009 and October 2018. The overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox analyses were used to evaluate the prognostic significance of RDW. Results The patients with bladder cancer were divided into two subgroups according to the RDW value (0.1395). A high RDW value significantly correlated with higher mortality, a decrease in hemoglobin, an increase in C-reactive protein, a decrease in RBC count, and T stage (P<0.05). Statistically significant differences in OS, CSS, and DFS were found between high- and low-RDW groups. Hence, a high RDW value was presumed to be a risk factor for poor prognosis in patients with bladder cancer after radical cystectomy (P<0.001). Conclusions Patients with a high RDW value had a poor prognosis. Therefore, RDW is a reliable predictor for the prognosis of patients with bladder cancer who underwent radical cystectomy.
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Affiliation(s)
- Wenchao Ma
- Shanghai Clinical College, Anhui Medical University, Hefei 230032, China.,Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Shiyu Mao
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Meiyu Bao
- Department of Central Laboratory, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Yuan Wu
- Shanghai Clinical College, Anhui Medical University, Hefei 230032, China
| | - Yadong Guo
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Ji Liu
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Ruiliang Wang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Cheng Li
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Junfeng Zhang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Wentao Zhang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Xudong Yao
- Shanghai Clinical College, Anhui Medical University, Hefei 230032, China.,Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
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Dogan P, Guney Varal I. Red cell distribution width as a predictor of late-onset Gram-negative sepsis. Pediatr Int 2020; 62:341-346. [PMID: 31880020 DOI: 10.1111/ped.14123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/15/2019] [Accepted: 11/18/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Late-onset sepsis (LOS) remains an important cause of morbidity and mortality in preterm infants. In this study, our aim was to investigate the red-cell distribution width (RDW) levels during a LOS episode, and its association with the type of growing microorganism and mortality. METHODS Preterm infants with culture-proven sepsis during their neonatal intensive care unit stay were enrolled. Red-cell distribution width levels were obtained in the first 4 h of postnatal life and at the onset of the LOS episode, and compared for these time frames. The study cohort was divided into two groups according to the type of the growing microorganism. The RDW levels were then assessed in intra- and inter-group analyses. RESULTS Eighty-six infants were included in the final analysis. RDW levels were increased in the study cohort after a LOS attack (P < 0.001). Infants with Gram-negative sepsis showed a significant increase in their RDW levels, but they remained unchanged in infants with Gram-positive sepsis (P < 0.001 and P = 0.4, respectively). An RDW cut-off of >19.50% was related with a sensitivity of 87% and a specificity of 81% for predicting late-onset Gram-negative sepsis (P < 0.001). Logistic regression analysis showed a positive association of RDW with mortality when adjusted for covariants (adjusted odds ratio: 1.40; 95% confidence interval: 1.02-1.80; P = 0.03). CONCLUSIONS Our findings show that RDW levels increased during a LOS episode in preterm infants, which was especially evident in Gram-negative infections. We believe that these findings may be of importance in the early diagnosis and prognosis of LOS in preterm infants.
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Affiliation(s)
- Pelin Dogan
- Division of Neonatology, Department of Pediatrics, Bursa Yüksek Ihtisas Teaching Hospital, University of Health Sciences, Bursa, Turkey
| | - Ipek Guney Varal
- Division of Neonatology, Department of Pediatrics, Bursa Yüksek Ihtisas Teaching Hospital, University of Health Sciences, Bursa, Turkey
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14
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Hsueh CY, Lau HC, Li S, Tao L, Zhang M, Gong H, Zhou L. Pretreatment Level of Red Cell Distribution Width as a Prognostic Indicator for Survival in a Large Cohort Study of Male Laryngeal Squamous Carcinoma. Front Oncol 2019; 9:271. [PMID: 31041191 PMCID: PMC6477051 DOI: 10.3389/fonc.2019.00271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/25/2019] [Indexed: 12/11/2022] Open
Abstract
Objective: High levels of red cell distribution width (RDW) may be associated with adverse outcomes in patients with cancer. The purpose of the present study was to investigate the prognostic impact of pretreatment RDW levels on overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) in a large cohort of male laryngeal squamous cell cancer (LSCC) patients. Methods: A total of 809 LSCC patients who were treated between 2007 and 2011 at the Eye & ENT Hospital of Fudan University were enrolled and evaluated retrospectively. OS, CSS, and DFS were analyzed using the Kaplan–Meier method. To evaluate the prognostic significance of RDW levels, univariate, and multivariate Cox analyses were applied. Results: Higher pretreatment RDW levels were significantly associated with high death events, red blood cell count, hemoglobin, radiotherapy, operation therapy, and advanced tumor stage (p < 0.05). From the univariate analysis, we observed that the higher (13.2–13.5%) and the highest (>13.5%) quartiles of RDW level were consistent factors for poor OS, CSS, and DFS in LSCC patients. In the multivariate analysis, after adjusting for confounding factors, the higher and highest quartiles of RDW levels were identified as independent prognostic factors in male LSCC patients. Conclusion: Higher pretreatment RDW levels were demonstrated to be associated with poor clinical outcome in male LSCC patients and might be novel markers for patient stratification in LSCC management.
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Affiliation(s)
- Chi-Yao Hsueh
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Hui-Ching Lau
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Shengjie Li
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lei Tao
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Ming Zhang
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Hongli Gong
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Liang Zhou
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
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