Prognostic Value of the post-operative Red Blood Cell Distribution Width in rectal cancer patients with neoadjuvant chemoradiation followed surgery.

Yingkun Ren,Jianguo Xie,Zhiling Wang,Peijun Wang

doi:10.1042/bsr20201822

Abstract

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.

Highlights

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the world [1], rectal cancer accounts for 30.7% of all cases of CRC, and the fatality rate ranks the fourth and the third for males and females, respectively [2]
red cell distribution width (RDW) has obtained increasing attention in cancer field and elevated RDW was related to poor prognosis in several cancers [19]
An increased cancer-related inflammation response inhibits the generate of erythropoietin, reduces iron release from reticuloendothelial macrophages, and shortens red blood cell survival through relevant inflammatory markers, which results in elevated RDW; the potential mechanism has not been demonstrated clearly [20]

Summary

Introduction

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the world [1], rectal cancer accounts for 30.7% of all cases of CRC, and the fatality rate ranks the fourth and the third for males and females, respectively [2]. Chemotherapy and immunity therapy had been developed in the past decade, the prognosis remains unsatisfactory because of the high recurrence rate and metastasis after these treatment. A growing study reports that NACRT benefiting in locally advanced patients (T3-4 and/or N+) with rectal cancer (LARC) followed by total mesorectal excision (TME), which has greatly reduced the local recurrence after resection, and increasing the rate of R0 resection [3]. NACRT was considered as a standard treatment in LARC patients [4,5]. Some patients still have poor prognosis for the local recurrence or distal metastatic after surgery.

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