Significance of the Red Blood Cell Distribution Width in Resected Pathologic Stage I Nonsmall Cell Lung Cancer

Abstract

Red blood cell distribution width (RDW) is a parameter measured in blood sample tests that reflects the variation in the volume of erythrocytes and used to differentiate an anemic state. The RDW has been used to predict a poor survival in various types of cancer; however, the prognostic impact of the RDW in resected pathologic stage I nonsmall cell lung cancer (NSCLC) patients remains to be elucidated. A total of 273 patients with resected pathologic stage I NSCLC were included in this study. The cut-off value of RDW was set at 14.5, which was the upper limit of the normal range of the RDW. The controlling nutritional status (CONUT) score, which was calculated by the albumin, cholesterol, and the lymphocyte count, was also investigated. Among 273 patients, 34 (12.5%) were RDW-high, while 239 (87.5%) were RDW-low. RDW-high was significantly associated with a lower body mass index (P < 0.01), a lower level of hemoglobin (P < 0.01), a higher level of C-reactive protein (P < 0.01), and a high CONUT score (P = 0.03) than RDW-low. Patients with RDW-high exhibited significantly shorter recurrence-free and overall survivals (RFS and OS, respectively) than those with RDW-low (P < 0.01 and P < 0.01, respectively). Multivariate analyses showed that the RDW was an independent prognostic factor for both the RFS and OS (RFS, hazard ratio [HR]: 2.16, 95% confidence interval [CI]: 1.14-3.95, P = 0.02; OS, HR: 2.44, 95% CI: 1.28-4.49, P < 0.01). The RDW was shown to be associated with a worse long-term prognosis in resected pathologic stage I NSCLC patients.