Abstract
BackgroundRecent 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.MethodThe 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.ResultsKaplan–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.ConclusionsPreoperative 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.
Highlights
Recent studies suggest red blood cell distribution width (RDW) was a prognostic factor in various types of cancer patients, the results are controversial
Preoperative low levels of RDW are associated with poor survival in intrahepatic cholangiocarcinoma (ICC) after curative resection
This provides a new way for predicting the prognosis of ICC patients and more targeted intervention measures
Summary
Recent studies suggest red blood cell distribution width (RDW) was a prognostic factor in various types of cancer patients, 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. Clear margins during resection are emphasized as the most important factor for good local control and a favorable prognosis; in addition, lymph node metastasis is one of the most significant prognostic factors for survival in ICC [2]. The prognosis of patients is closely related to whether radical resection can be performed, but the radical resection rate of ICC is only 15 to 20%, far lower than the surgical resection rate of 70% for distal cholangiocarcinoma. Even though patients with ICC who undergo extended resection still have a poor prognosis, this is closely related to the high incidence of local recurrence and distant metastasis [3]. We should attach great importance to this kind of malignant disease in the clinic
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