Abstract
BackgroundRed cell distribution width (RDW), one of many routinely examined parameters, shows the heterogeneity in erythrocyte size. We investigated the association of RDW levels with clinical parameters and prognosis of lung cancer patients.MethodsClinical and laboratory data from 332 patients with lung cancer in a single institution were retrospectively studied by univariate analysis. Kaplan-Meier survival analysis and Cox proportional hazard models were used to examine the effect of RDW on survival.ResultsThe RDW levels were divided into two groups: high RDW (>=15%), n=73 vs. low RDW, n=259 (<15%). Univariate analysis showed that there were significant associations of high RDW values with cancer stage, performance status, presence of other disease, white blood cell count, hemoglobin, mean corpuscular volume, platelet count, albumin level, C-reactive protein level, and cytokeratin 19 fragment level. Kruskal-Wallis tests revealed an association of RDW values with cancer stage in patients irrespective of comorbidity (patient with/without comorbidity: p<0.0001, patient without comorbidity: p<0.0001). Stages I-IV lung cancer patients with higher RDW values had poorer prognoses than those with lower RDW values (Wilcoxon test: p=0.002). In particular, the survival rates of stage I and II patients (n=141) were lower in the high RDW group (n=19) than in the low RDW group (n=122) (Wilcoxon test: p<0.001). Moreover, multivariate analysis showed higher RDW is a significant prognostic factor (p=0.040).ConclusionRDW is associated with several factors that reflect inflammation and malnutrition in lung cancer patients. Moreover, high levels of RDW are associated with poor survival. RDW might be used as a new and convenient marker to determine a patient’s general condition and to predict the mortality risk of lung cancer patients.
Highlights
Red cell distribution width (RDW) is routinely examined with the complete blood count (CBC) test that shows the heterogeneity in erythrocyte size
We revealed two major findings: (1) RDW values were positively associated with clinical cancer stage; and (2) patients with higher RDW values had poorer prognoses
And 3, advanced stage, poorer performance status (PS), high white blood cell (WBC), lower albumin, and higher C-reactive protein (CRP) were associated with high RDW. This result might support the idea that high levels of RDW reflect chronic inflammation and poor nutritional status of patients with lung cancer
Summary
Red cell distribution width (RDW) is routinely examined with the complete blood count (CBC) test that shows the heterogeneity in erythrocyte size. The activity of inflammatory bowel disease [9], and pulmonary functions [10] have been reported to be associated with RDW values The mechanism underlying those associations of RDW with survival or disease activity has not been elucidated, but high levels of RDW are thought to be provoked by chronic inflammation, poor nutritional status (e.g. iron, folate, and vitamin B12 deficiency), and age-associated diseases via changes in erythropoiesis [1,11,12]. The resulting low performance status (PS) and compromised nutritional status account for the patient’s poor quality of life, and are obstacles in cancer treatment Markers such as age, PS and disease stage are used to risk-stratify patients and guide therapeutic strategy. Univariate analysis showed that there were significant associations of high RDW values with cancer stage, performance status, presence of other disease, white blood cell count, hemoglobin, mean corpuscular volume, platelet count, albumin level, C-reactive protein level, and cytokeratin 19 fragment level. RDW might be used as a new and convenient marker to determine a patient’s general condition and to predict the mortality risk of lung cancer patients
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