Skeletal Muscle Index to Red Cell Distribution Width Ratio: A Novel Prognostic Indicator for Patients with Stage I-III Colorectal Cancer.

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.

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.

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.

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.

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.

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.

Simple SummaryThe association between red blood cell distribution width (RDW) and the prognosis of certain cancers has been established. However, RDW is also related to age, nutrition status, and many systemic disorders. Therefore, it is still unclear whether the association is contributed by these confounders. Here, we present a propensity-score match study demonstrating that RDW is an independently negative predictor for overall survival, disease-free survival, and cancer-specific survival in patients with stage I-II colorectal cancer.The red blood cell distribution width (RDW) is a simple and widely available parameter obtained from a complete blood cell count test and is usually used in the analysis of anemia. Recently, studies have discovered the association between RDW and the host inflammatory response of cancer patients. We aimed to determine the prognostic value of RDW in colorectal cancer (CRC) patients. 5315 total patients with stage I-II CRC from the Chang Gung Memorial Hospital between 2001 and 2018 were enrolled. The study cohort was divided into two groups using RDW = 13.8 as the cutoff value as determined by receiver operating curve. High RDW had worse overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS), and was also independently related to older age, more advanced tumor stage, lower albumin level, lower hemoglobin level, and more co-morbidities including diabetes, hypertension, and chronic kidney disease. We performed a propensity-score matched analysis to balance the heterogeneity between the two groups and to reduce the influence of confounding factors that may have compromised the prognosis. High RDW remained a negative predictor of OS (HR = 1.49, 95% CI: 1.25–1.78), as well as DFS and CSS. In conclusion, this is the first report using propensity matching to demonstrate the relationship between RDW and the prognosis of early-stage CRC patients.

BackgroundThe Skeletal Muscle Index (SMI) serves as an objective metric for assessing nutritional status in patients with malignant tumors. Research has found baseline nutritional status can influence both the efficacy and prognosis of targeted anti-tumor therapies, with growth factor tyrosine kinase inhibitors frequently inducing drug-related sarcopenia. Fruquintinib has received approval for the treatment of metastatic colorectal cancer. This study examines the prognostic significance of baseline SMI in patients with metastatic colorectal cancer undergoing treatment with fruquintinib. Additionally, the study investigates the incidence of SMI reduction following fruquintinib therapy to assess its impact on patient prognosis.MethodsA retrospective multicenter study was conducted to analyze patients with metastatic colorectal cancer who received fruquintinib treatment across eight medical centers in Eastern China. The muscle area at the third lumbar vertebra was assessed, and both baseline and post-treatment SMI values were calculated independently. The relationship between SMI and patient survival was subsequently examined.ResultsThe median progression-free survival (PFS) for the cohort of 105 patients was 4.2 months (95% CI, 3.7 to 4.9 months), while the median overall survival (OS) was 10.2 months (95% CI, 9.0 to 12.7 months). Notably, the baseline SMI prior to the initiation of fruquintinib therapy exhibited a significant correlation with OS (P = 0.0077). Multivariate analysis indicated that baseline SMI serves as an independent prognostic factor for OS (P = 0.005). Furthermore, after Propensity Score Matching (PSM) analysis, there was still a significant correlation between baseline SMI and OS. Among the patients, 28.87% developed sarcopenia following oral administration of fruquintinib. However, no statistically significant difference in OS was observed between the group with reduced SMI and the group without SMI reduction after treatment with fruquintinib.ConclusionThe baseline SMI was identified as an independent prognostic factor for OS and may influence the survival outcomes of patients with metastatic colorectal cancer undergoing treatment with fruquintinib. Despite the potential of fruquintinib to induce sarcopenia, no significant correlation was observed between changes in SMI following treatment and patient survival.

Hemoglobin - to - red cell distribution width ratio in depression symptoms: Threshold effects and metabolic - inflammatory mediation revealed by multimodal machine learning and symptom network analysis in 196,260 adults.

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.

Background We aimed to investigate the prognostic value of red cell distribution width (RDW) in metastatic renal cell carcinoma (mRCC) patients treated with targeted therapy, including sunitinib and pazopanib. Methods A total of 104 mRCC patients were included. The Kaplan–Meier method was used to estimate overall survival (OS) and progression-free survival (PFS), and the long-rank test was used for comparison. Univariate and multivariate Cox proportional hazards models were used to determine the association between RDW and PFS and OS. Results The PFS and OS of all cohorts were 11.8 mo and 25.9 mo, respectively. Receiver operating characteristic analysis revealed that RDW level ≥15.4 was the optimal cutoff value for OS prediction with 73.53% sensitivity and 61.11% specificity (area under curve: 0.64, P = 0.012). RDW level ≥15.4 was found as an independent prognostic parameter for OS when adjusted for the number of covariates, including the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) scoring system (hazard ratio: 1.125, 95% confidence interval: 1.024–2.235, P = 0.014). Conclusions Our study revealed that high RDW level, a routinely and easily assessed marker, was significantly associated with worse survival outcomes in mRCC patients treated with targeted therapy.

Red Cell Distribution Width (RDW) at Diagnosis of Diffuse Large B-Cell Lymphoma (DLBCL) Is Associated to Higher Mortality and Worse Overall Survival

Red Cells Distribution Width and Prognosis in Myelofibrosis Patients Treated with Ruxolitinib

Previous studies have shown an independent association between increased red cell distribution width (RDW) and mortality after acute myocardial infarction (AMI). However, evidence regarding the predictive significance of repeated measures of RDW in patients with AMI remains scarce. We aimed to investigate the association between the dynamic profile of RDW and in-hospital mortality in patients with AMI.This was a cross-sectional study. We extracted clinical data from the Medical Information Mart for Intensive Care IIIV1.4 database. Demographic data, vital signs, laboratory test data, and comorbidities were collected from the database. The clinical endpoint was in-hospital mortality. Cox proportional hazards models were used to evaluate the prognostic values of basic RDW, and the Kaplan–Meier method was used to plot survival curves. Subgroup analyses were performed to measure mortality across various subgroups. The repeated-measures data were compared using a generalized additive mixed model.In total, 3101eligible patients were included. In multivariate analysis, adjusted for age, sex, and ethnicity, RDW was a significant risk predictor of in-hospital mortality. Furthermore, after adjusting for more confounding factors, RDW remained a significant predictor of in-hospital mortality (tertile 3 vs tertile 1: hazard ratio 2.3; 95% confidence interval 1.39–4.01; P for trend <.05). The Kaplan–Meier curve for tertiles of RDW indicated that survival rates were highest when RDW was ≤13.2% and lowest when RDW was ≥14.2% after adjustment for age, sex, and ethnicity. During the intensive care unit stay, the RDW of nonsurvivors progressively increased until death occurred.Our findings showed that a higher RDW was associated with an increased risk of in-hospital mortality in patients with AMI.

Aims Gastric cancer (GC) is often diagnosed at an advanced stage; inexpensive and valid biomarkers for GC are still unavailable. We aimed to evaluate the prognosis of the combination of pretreatment red cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) in patients with GC. Methods A retrospective analysis from 103 GC patients who were diagnosed at our institution from 2012 to 2016 was performed. Both pretreatment RDW and NLR were calculated based on the recommended cutoff values of 13.4% and 2.755, respectively. Combined values of RDW and NLR (RDW + NLR) stratified patients into a score of 0 (RDW ≤ 13.4% and NLR ≤ 2.755), a score of 1 (RDW > 13.4% or NLR > 2.755), and a score of 2 (RDW > 13.4% and NLR > 2.755). Prognostic significances for overall survival (OS) and progression-free survival (PFS) were assessed. Results Pretreatment RDW + NLR was a significantly independent prognostic factor for OS and PFS. Moreover, high RDW + NLR was strongly related to age, tumor location, TNM stage, CA125, and CA199. In a subgroup analysis for patients with advanced gastric cancer (AGC), we observed that the level of RDW + NLR was markedly associated with OS and PFS. Conclusion Pretreatment RDW + NLR is a simple, inexpensive, and valid prognostic system to predict the survival in patients with GC, especially AGC.