Clinical significance of preoperative red cell distribution width-to-albumin ratio in predicting survival after curative surgery for gastric cancer: a retrospective cohort study

The aim of the current study was to investigate the impact of the preoperative red cell distribution width (RDW) value on the overall survival (OS) and cancer-specific survival (CSS) of gastric cancer patients. A total of 366 gastric cancer patients who underwent curative gastrectomy were retrospectively reviewed. Among them, RDW was evaluated in 165 non-elderly and 201 elderly patients. Multivariate analysis revealed that pathological stage (pStage), RDW, and carcinoembryonic antigen (CEA), were independent prognostic factors of OS, while pStage and RDW were independent prognostic factors of CSS. In non-elderly patients, based on the multivariate analysis, pStage, adjuvant chemotherapy, and RDW were identified as independent prognostic factors of OS. In elderly patients, RDW was identified as independent prognostic factors of OS and CSS. Preoperative RDW is a promising independent prognostic factor in gastric cancer.

Increased preoperative red cell distribution width (RDW) is associated with poor prognosis in several cancers, but the relationships between preoperative RDW and changes in RDW (ΔRDW) and colorectal cancer (CRC) prognosis remain unclear. Our study aimed to demonstrate the prognostic significance of increased preoperative RDW and ΔRDW for CRC. In this retrospective analysis, we enrolled 833 patients who underwent CRC surgery between 2015 and 2019 at the Affiliated Hospital of Xuzhou Medical University, China. ΔRDW in our study was defined as RDW at 1 month after discharge minus preoperative RDW. According to receiver operating characteristic (ROC) curve analysis, we used cut-off values of 13.5% for RDW, 0.9% for ΔRDW. The cumulative survival rate was determined using the Kaplan-Meier method, and significant differences were evaluated by the log-rank test. Multivariable Cox regression model was applied to clarify the independent risk factors for overall survival (OS), which were used to construct a nomogram prediction model. The competing risk method was also applied, and we analyzed only patients with early-stage disease (stage 0-II) for sensitivity analysis. Multivariable Cox regression analysis demonstrated that age, RDW, ΔRDW, postoperative adjuvant chemotherapy, CEA, CA19-9, ASA, TNM stage, and pathological type were independent factors for OS in CRC patients (all p < 0.05). These prognostic factors were used to establish and verify the OS nomogram. Poorer OS was linked to higher RDW (HR = 1.52; 95% CI, 1.11-2.08; p < 0.01) and ΔRDW (HR = 1.65; 95% CI, 1.19-2.28; p < 0.01) in all-stage patients, and was only linked to higher RDW in early-stage patients. In competing risk model, H-RDW and H-ΔRDW were confirmed to be independent risk factors for CSS in CRC patients. High preoperative RDW and ΔRDW are both risk factors for OS and CSS in CRC.

Aim. In our study, we researched whether on-pump and off-pump coronary artery bypass grafting (CABG) differ as regards their effect on postoperative red cell distribution width (RDW). Moreover, we also investigated whether there was a link between the preoperative and postoperative RDW levels and the early adverse events after CABG. Material and methods. In this study there were 127 consecutive patients who had previously undergone CABG. The patients were divided as group 1 (off-pump, n: 49) and group 2 (on-pump, n: 78). The hemogram and biochemistry panel values were measured a day before the operation, on the first, third and seventh days after it, and in the postoperative first and sixth months. Results. The statistically significant values detected in the hemogram were as follows: postoperative first day hemoglobin, postoperative first day leukocyte, postoperative first day thrombocyte, postoperative first day C-reactive protein, postoperative third day RDW, postoperative third day leukocyte, postoperative seventh day RDW, postoperative seventh day leukocyte, postoperative first month RDW, and postoperative first month thrombocyte (p&lt;0,05). It was found in multivariate analysis that preoperative RDW is an independent risk factor for plasma used in the postoperative period (odds ratio: 0.552; 95% CI: 0.346–0.879; P=0.012). There was no link between preoperative RDW and other early adverse events in the postoperative period (p&gt;0,05). Conclusion. We found that on-pump CABG increases the RDW levels more in the acute period, when compared with off-pump surgery, but that this effect disappears by the sixth month after the operation. For this reason, RDW can be used as a new inflammatory marker in patients undergoing CABG. Moreover, we observed that there was no clinical link between early adverse events after CABG and the pre- and postoperative RDW levels.

Prognostic Significance of Pre- and Post-operative Red-Cell Distribution Width in Patients with Gastric Cancer

ObjectiveAccumulating studies report that levels of mean corpuscular volume (MCV) and red cell distribution width (RDW) are associated with outcomes in cancer patients, while studies including MCV and RDW in chordoma are lacking so far. Therefore, our study aims to investigate the prognostic impact of MCV and RDW on survival in skull base chordoma patients.MethodsLevels of preoperative MCV and RDW in 187 primary skull base chordoma patients were collected. X-tile software was used to find the cutoff values of MCV and RDW. Progression-free survival (PFS) and overall survival (OS) analyses were performed using the Kaplan–Meier methods, Cox analysis, and nomogram model.ResultsLow MCV level (MCV <84.2) was more commonly observed in classical chordoma patients (p=0.022). High RDW level (RDW≥12.7) was correlated with older patient age (p=0.022) and a tough tumor texture (p=0.035). Low MCV level and high RDW level were associated with poor PFS (p=0.045 and 0.007, respectively) and OS (p=0.023 and <0.001, respectively). Multivariate Cox analysis demonstrated that RDW was an independent prognostic indicator for both PFS (p=0.001) and OS (p<0.001). Importantly, a nomogram based on RDW and clinical predictors showed satisfactory performance for PFS and OS prediction (concordance index, C-index: 0.684 and 0.744, respectively).ConclusionOur data was first to reveal the prognostic role of RDW in skull base chordoma, and identified the use of RDW may contribute to a more accurate prognosis judgment and personalized treatment decision.

BackgroundSystemic inflammatory markers, particularly pretreatment red cell distribution width (RDW) and hemoglobin to red cell distribution width ratio (HRR), have been associated with prognosis in several cancers. This study aimed to investigate the relationship between the preoperative RDW, HRR and clinicopathologic characteristics of patients undergoing total laryngectomy and their correlation with prognosis.MethodsThe optimal cut-off values of RDW and HRR to the overall survival (OS) of patients were determined by the receiver operating characteristic (ROC) curves, which in turn divided the patients into high-value and low-value groups for further stratified analyses. Patient survival was analyzed using Kaplan-Meier survival curves. Additionally, univariate and multivariate Cox regression analyses were conducted to evaluate the predictive roles of RDW and HRR on the prognosis of patients following total laryngectomy.ResultsThe high RDW group demonstrated statistically significant associations with TNM clinical stage, cervical lymph node metastasis, and vascular infiltration (P < 0.05). Similarly, the low HRR group exhibited significant associations with gender, histologic grade, TNM clinical stage, cervical lymph node metastasis, and vascular infiltration (P < 0.05).The optimal cut-off values for predicting overall survival (OS) for patients, as determined by ROC curves, were 13.75 for RDW and 10.79 for HRR. Additionally, RDW emerged as an independent prognostic factor for OS in this population (HR = 3.060, 95% CI 2.222–4.215, P < 0.001).ConclusionPreoperative RDW and HRR are prognostic risk factors for OS in patients undergoing total laryngectomy, with RDW serving as an independent predictor of prognosis.

Red cell distribution width (RDW) can signal poor prognosis in inflammatory medical conditions. The purpose of the study was to investigate the relationship between preoperative RDW and colorectal cancer (CRC) in a large cohort of patients. A total of 6,224 CRC patients who underwent radical resection at the Fudan University Shanghai Cancer Center were evaluated retrospectively. The prognostic significance of RDW for overall survival (OS) and disease-free survival (DFS) was analyzed using Cox proportional hazards models and Kaplan-Meier method. Propensity score matching (PSM) was used based on survival confounding factors. The mean age of the study participants was 59.5±12.0 years and the study cohort was 44% female. The overall median and mean RDW values were 13.3% and 14.0%, respectively. Patients were stratified into three groups based on their RDW value (≤13.3%, 13.4-14.0%, and >14.0%). OS and DFS were shown to significantly deteriorate with increasing RDW category. In the PSM population, OS and DFS were significantly lower in the high RDW group compared with matched controls. However, the differences vanished in the comparisons between the middle RDW group and the control group. Our findings demonstrate that preoperative RDW may represent a simple and powerful prognostic factor for CRC patients after radical resection. Integrating RDW into clinical practice may better inform the prognosis and optimize therapeutic approaches for patients with CRC.

BackgroundAlthough red cell distribution width (RDW) has been linked to venous thromboembolism, its predictive value for postoperative pulmonary embolism (PE) in surgical trauma patients remains ambiguous. This study aimed to investigate the correlation between preoperative RDW and postoperative PE risk.MethodsWe incorporated 46506 surgical trauma patients from three medical institutions and the MIMIC-IV 2.2 database. We constructed receiver operating characteristic curves (ROC) utilizing preoperative (at admission) RDW and postoperative PE and classified patients into two groups. Firstly, univariate logistic regression was conducted to identify factors correlated with postoperative PE, and the variance inflation factor was computed to evaluate multicollinearity. Multivariate logistic regression analysis was subsequently conducted to identify the independent risk factors for PE. Propensity score matching (PSM) was conducted using a caliper value of 0.1, balancing 26 covariates between the two groups, including demographic features, vital signs, injury severity scores, comorbidities, and laboratory parameters. A total of 10235 pairs were successfully matched.ResultsThe postoperative PE incidence was 0.56%. RDW showed significant predictive value for PE with an area under the curve (AUC) of 0.723 (0.696-0.750). Before PSM, RDW ≥14.4% was associated with increased PE risk (OR 4.70, 95% CI 3.63-6.09, P < 0.001). Multivariate analysis confirmed a 1.90–fold risk increase (95% CI 1.42-2.55, P < 0.001). After PSM, RDW ≥14.4% remained significantly associated with higher PE risk (OR 1.67, 95% CI 1.22-2.29, P = 0.002).ConclusionElevated preoperative RDW is an independent risk factor for postoperative PE in trauma patients, with ≥14.4% indicating significantly increased risk.

BackgroundPlatelet distribution width (PDW) and red cell distribution width (RDW) are readily obtainable data, and are reportedly useful as prognostic indicators in some cancers. However, their prognostic significance is unclear in gastric cancer (GC).MethodsWe enrolled 445 patients with histopathological diagnoses of gastric adenocarcinoma who had undergone curative surgeries.ResultsAccording to the optimal cut-off value of PDW and RDW by receiver operating characteristic (ROC) analysis, we divided patients into PDWHigh (≥ 16.75%), PDWLow (< 16.75%), RDWHigh (≥ 14.25%), and RDWLow (< 14.25%) subgroups. Overall survival (OS) was significantly worse in patients with PDWHigh than in those with PDWLow (P = 0.0015), as was disease specific survival (P = 0.043). OS was also significantly worse in patients with RDWHigh than in those with RDWLow (P < 0.0001), as was disease specific survival (P = 0.0002). Multivariate analysis for OS revealed that both PDW and RDW were independent prognostic indicators. Patients were then given PDW-RDW score by adding points for their different subgroups (1 point each for PDWHigh and RDWHigh; 0 points for PDWLow and RDWLow). OS significantly differed by PDW-RDW score (P < 0.0001), as did disease specific survival (P = 0.0005). In multivariate analysis for OS, PDW-RDW score was found to be an independent prognostic indicator.ConclusionsThe prognosis of GC patients can be precisely predictable by using both PDW and RDW.

e20031 Background: Elevated red cell distribution width (RDW) has been associated with all-cause mortality, risk of developing cancer and cancer mortality in large retrospective studies. The underlying mechanism may be due to inflammatory and nutritional abnormalities. We hypothesized DLBCL patients with an elevated RDW at the time of diagnosis would have a worse prognosis. Methods: A retrospective single-institution study included 541 DLBCL patients diagnosed between 2001 and 2016. RDW over 14.5% was considered high, as this was the upper limit of normal at our institution. The overall and progression free survival was estimated using Kaplan-Meier methods, and the difference between groups was compared using the log-rank test. Univariate and multivariate analyses were performed with Cox proportional hazards regression. Results: We identified 410 DLBCL pts with available baseline RDW, 229 (56%) had RDW &gt; 14.5. Median follow up from diagnosis was 60 months. The complete response rate was 63.8% in the group with high RDW (n = 152) and 88.4% in the normal RDW group (n = 216, p &lt; 0.0001) . For patients with high RDW, 1-year overall survival (OS) was 65% (95%CI 0.58-0.72) vs 90% (95%CI 0.87-0.94) for pts with normal RDW &lt; / = 14.5; 2-year OS was 57% (95%CI 0.50-0.65) vs 84% (95%CI 0.79-0.89), respectively (p &lt; 0.0001). This difference remained statistically significant when the analysis was restricted to patients treated with anthracycline-containing regimens given with curative intent (2y OS = 66% vs. 87.5%, p &lt; 0.0001). Univariate analysis revealed that R-IPI, high RDW, elevated LDH, albumin &lt; 3.5mg/dl, Hgb &lt; 10g/dl, advanced stage disease, bulky disease, extra nodal disease, and ECOG performance status 3-4 were associated with worse OS. In multivariate analysis, older age (HR 2.07, 95%CI 1.38-3.1), high RDW (HR 1.68, 95%CI 1.15-2.5), albumin &lt; 3.5mg/dl (HR 1.76, 95%CI 1.18-2.6) and ECOG 3-4 (HR 2.47, 95%CI 1.47-4.2) were independent prognostic factors for OS. Conclusions: High RDW is associated with worse response rates and independently associated with worse OS in patients with DLBCL. Based on our study, DLBCL patients with high RDW at diagnosis should be considered at higher risk of mortality and treatment failure. Further research is needed to clarify the underlying mechanism and to evaluate the utility of incorporating RDW into prognostic indices.

The neutrophil to lymphocyte ratio (NLR) and red blood cell distribution width (RDW) play an important role in the prognosis of several cancers, but their prognostic value in patients with stage II-III gastric cancer (GC) is unclear. We aimed to evaluate the prognostic value of the RDW-NLR (R-NLR) score based on RDW and NLR in stage II-III GC patients after radical surgery. Preoperative RDW and NLR clinicopathological data were retrospectively reviewed and analyzed from stage II-III GC patients who underwent radical gastrectomy. The optimal cut-off values for pre-RDW-variation coefficient (pre-RDW-cv) and pre-NLR were defined as 14.10% and 2.015, respectively. The R-NLR score was defined as 2 (both elevated RDW and NLR), 1 (one of these was elevated), or 0 (neither were elevated). Prognostic factors were identified by univariate and multivariate analyses. A total of 151 patients were included in this study, and 65 (43.05%), 54 (35.76%), and 32 (21.19%) patients had an R-NLR score of 0, 1 and 2, respectively. The preoperative R-NLR score was significantly correlated with tumor size and gender (all P<0.05). The 5-year overall survival (OS) in the R-NLR 0, 1, and 2 groups was 52.30%, 44.40%, and 31.20%, respectively (P=0.031), while the 5-year DFS was 47.70%, 13.30%, and 18.80%, respectively (P<0.001). Further, while the 5-year disease-free survival (DFS) rate was significantly improved in low RDW-cv and NLR patients compared with those with high RDW-cv and NLR (all P<0.05), but not OS (all P>0.05). Multivariate analysis demonstrated that the R-NLR score was independently correlated with OS [hazard ratio (HR), 1.527; P=0.007] and DFS (HR, 1.939; P=0.001). We validated the preoperative R-NLR score to be a promising predictor for stage II-III GC patients who have undergone radical gastrectomy.

Severe burns cause pathophysiological processes that result in mortality. A laboratory biomarker, red cell distribution width (RDW), is known as a predictor of mortality in critically-ill patients. We examined the association between RDW and postoperative mortality in severe burn patients. We retrospectively analyzed medical data of 731 severely burned patients who underwent surgery under general anesthesia. We evaluated whether preoperative RDW value can predict 3-month mortality after burn surgery using receiver operating characteristic (ROC) curve analysis, logistic regression, and Cox proportional-hazards regression analysis. Mortality was also analyzed according to preoperative RDW values and incidence of postoperative acute kidney injury (AKI). The 3-month mortality rate after burn surgery was 27.1% (198/731). The area under the ROC curve of preoperative RDW to predict mortality after burn surgery was 0.701 (95% confidence interval [CI], 0.667-0.734; P < 0.001) with a cut-off point of 12.9. The adjusted hazard ratio in patients with RDW > 12.9 was 1.238 (95% CI, 1.138-1.347; P < 0.001). Subgroup analysis showed that the survival rate was 88.8% for the non-AKI group with RDW ≤ 12.9 and 17.6% for the AKI group with RDW > 12.9. Preoperative RDW was considered an independent risk factor for mortality (odds ratio, 1.679; 95% CI, 1.378- 2.046; P < 0.001). Preoperative RDW may predict 3-month postoperative mortality in patients with severe burns, while preoperative RDW > 12.9 and postoperative AKI may further increase mortality after burn surgery.

BackgroundBladder 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.MethodsThis 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.ResultsThe 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).ConclusionsPatients 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.

Purposes: Several studies have reported that elevated red cell distribution width (RDW) is related to poor prognosis in several cancers; however, the prognostic significance of perioperative RDW in patients with rectal cancer that received neoadjuvant chemoradiation therapy (NACRT) is unclear.Methods: A total of 120 patients with rectal cancer who received NACRT followed surgery were retrospectively reviewed from Affiliated Cancer Hospital of Zhengzhou University between 2013 and 2015. Data for peripheral blood tests prior to the initiation of NACRT, before surgery and first chemotherapy after surgery were collected, respectively. The optimal cutoff values of RDW were determined by ROC analysis, respectively. The relationship between RDW and the prognosis of patients was evaluated by the Kaplan Meier method, respectively.Results: The post-operative RDWHigh patients had significantly worse 5-year overall survival (OS, P=0.001) and disease-free survival (DFS, P<0.001) than the post-operative RDWLow patients, respectively. Whereas high pre-operative RDW was the only marker correlated with worse DFS (P=0.005) than the pre-operative RDWLow patients, no relationship was found between pre-RDW and prognosis (OS, P=0.069; DFS, P=0.133). Multivariate analysis showed post-operative RDW had better predictive value than pre-RDW and pre-operative RDW.Conclusion: Post-operative RDW might be a useful prognostic indicator in patients with rectal cancer received neoadjuvant chemoradiation.

We have read the article ‘Preoperative red cell distribution width (RDW) in patients undergoing pulmonary resections for nonsmall-cell lung cancer’ by Warwick et al. [1]. They aimed to investigate the association of red cell distribution width (RDW) in patients undergoing lung resections for non-small-cell lung cancer with respect to in-hospital morbidity, mortality and longterm survival. They concluded that RDW is a significant factor after risk adjustment, determining in-hospital morbidity, mortality and long-term survival in patients undergoing post-potentially curative resections for non-small-cell lung cancer. RDW is a measure of the variability in the size of circulating erythrocytes and is expressed as the coefficient of variation of the erythrocyte volume. As several routine haematology instruments can analyse erythrocyte volume, RDW is available in most clinical settings. RDW independently predicts long-term mortality in many clinical conditions [2]. It is reported routinely as part of the full blood count, and it may be elevated by inflammation, uraemia and transfusion history. Recently, a number of studies have demonstrated that elevated RDW levels are associated with poor prognosis in the setting of coronary artery disease, coronary bypass surgery, heart failure, stroke, peripheral arterial disease and older age [3]. Nowadays, although anaemia is a predictor of postoperative complications and is a risk factor for mortality in post-cardiac surgery patients, RDW is described as an independent early marker of haemoglobin evolution and an independently identified risk factor for new-onset anaemia, providing predictive information for haematological abnormalities beyond haemoglobin concentrations and other known risk factors. It is commonly used as a method for the differential diagnosis of anaemia and could be elevated in any conditions, where reticulocytes are released into circulation [4]. However, the value of RDW is instrument dependent, forcing each laboratory to establish its own reference values. A common underlying cause of high RDW is iron or B12/folate deficiency, where normal erythrocytes are mixed with smaller or larger ones produced during the deficiency. The correlation with bilirubin could also be due to liver damage and excessive alcohol intake, resulting in macrocytosis and increased RDW. Additionally, not only RDW but also mean platelet volume, neutrophil lymphocyte ratio [5], C-reactive protein, gamma-glutamyl transferase and uric acid are easy methods to evaluate the prognosis of the patients. These markers might be helpful in clinical practice. Finally, because Warwick et al. [1] evaluated patients undergoing pulmonary resections for non-small-cell lung cancer retrospectively in their study, the authors might not accurately define how much time elapsed before measuring RDW levels; delaying blood sampling can cause abnormal results in RDWmeasurements [6]. In conclusion, RDW are affected by many conditions. So one should keep in mind that RDW itself without other inflammatory indicators may not give exact information to clinicians about the inflammatory status and prognostic indication of the patients. Finally, from that point of view, we think that it should be evaluated taking into consideration other serum inflammatory markers.