Clinical and prognostic significance of anisocytosis measured as a red cell distribution width in patients with colorectal cancer

Kust, Davor; Lucijanić, Marko; Urch, Kristina; Šamija, Ivan; Ćelap, Ivana; Kruljac, Ivan; Prpić, Marin; Lucijanić, Ivica; Mateša, Neven; Bolanča, Ante

doi:10.1093/qjmed/hcw223

Cited by 27 publications

(29 citation statements)

References 27 publications

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“…RDW was also found to be higher in more advanced T stages, N stages and in the presents of metastases. Similarly, Kust et al 24 , www.nature.com/scientificreports www.nature.com/scientificreports/ in a retrospective study of 90 patients with CRC, found that H-RDW was associated to a poorer overall survival. However, H-RDW was a negative prognostic factor only in stage II cancers.…”

Section: Discussionmentioning

confidence: 82%

Prognostic value of red cell distribution width (RDW) in colorectal cancer. Results from a single-center cohort on 591 patients

Pedrazzani

Tripepi

Turri

et al. 2020

Sci Rep

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Increasing evidence advocates the prognostic role of RDW in various tumours. We analysed 591 patients to assess whether RDW is a prognostic factor for overall (oS) and cancer-related survival (cRS) for patients with colorectal cancer (cRc). the data were retrieved from a retrospective database. the optimal cutoff value for RDW was set at 14.1%; accordingly, two groups were considered: those with a value equal or lower than 14.1% (L-RDW), and those with a value higher than 14.1% (H-RDW). The mean value of RDW rose from pT1 to pT4 tumours. H-RDW correlated with age above the mean, colonic location of the lesion, pT and TNM stage. Finally, H-RDW was significantly associated with the intent of surgery: almost 50% of patients who underwent a non-curative resection presented H-RDW, compared to 19.3% in R0 resections. OS was significantly lower in patients with H-RDW. CRS was similar in the two groups. Stratifying patients according to TNM stage worse OS was associated with H-RDW only in early stages, whereas there was no difference for stages II-IV. Multivariate analysis confirmed that H-RDW was not an independent prognostic factor. Although H-RDW correlated with some negative clinicalpathological factors, it did not seem to independently influence OS and CRS. Colorectal cancer (CRC) is the third most common cancer worldwide, with more than 1 million new cases and 600.000 deaths per year 1. Several biochemical markers related to the inflammatory processes that accompanies this malignancy have recently surged as diagnostic and prognostic tools 2-4. Beside classical 'inflammatory related' markers such as acute phase proteins (CRP and globulins), also parameters that reflect changes in certain bone marrow lineages such as PLR and NLR have been described 2,5. Amongst these, red blood cell distribution width (RDW) is a parameter that reflects the size heterogeneity of red blood cells and is normally used to differentiate various types of anemia 6. More recently, RDW has surged as a biochemical marker in several chronic inflammatory and cardiovascular disease 7-9. Recent reports have shown how it can be used as a prognostic marker in various cancer such as, lung, liver, esophago-gastric and breast 10-15. RDW has been studied as a potential prognostic marker also in CRC. In the context of this malignancy, however, its role remains unclear, as reports so far published have shown inconsistent results. The aim of this retrospective study was to evaluate the prognostic value of red blood cell distribution width in a large cohort of patients undergoing surgery for colorectal cancer.

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Section: Discussionmentioning

confidence: 82%

Prognostic value of red cell distribution width (RDW) in colorectal cancer. Results from a single-center cohort on 591 patients

Pedrazzani

Tripepi

Turri

et al. 2020

Sci Rep

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“…This is consistent with findings in other studies, elevated RDW levels have been shown to be an independent marker for mortality after colorectal cancer surgery, coronary bypass surgery and in elderly patients who underwent fixation of hip fracture. [ 17 – 20 , 51 ] While we do not have data in our study on the cause of mortality, elevated RDW have been associated with an increased risk of cardiovascular events and all-cause mortality in patients with and without cardiovascular disease[ 14 , 16 , 41 , 52 ]. Elevated RDW is also associated with stroke occurrence[ 53 ] and increased all-cause mortality in patients admitted to intensive care[ 54 – 57 ].…”

Section: Discussionmentioning

confidence: 99%

“…High preoperative RDW levels is associated with reduced survival after colorectal cancer surgery, in children undergoing surgical repair of congenital heart disease, and in elderly patients who underwent fixation of hip fracture. [ 17 – 20 ] It has been postulated that higher RDW levels reflects abnormal bone marrow activity, which may be due to chronic malnutrition, inflammation or high levels of circulating reactive oxygen species. [ 21 – 25 ] High RDW levels are found in a heterogeneous group of conditions, which can be further categorized by the MCV levels [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of preoperative anemia, abnormal mean corpuscular volume and red cell distribution width among surgical patients in Singapore, and their influence on one year mortality

et al. 2017

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IntroductionPreoperative anemia and high red cell distribution width (RDW) are associated with higher perioperative mortality. Conditions with high RDW levels can be categorized by mean corpuscular volume (MCV). The relationship between RDW, anemia and MCV may explain causality between high RDW levels and outcomes. We aim to establish the prevalence of preoperative anemia and distribution of RDW and MCV among pre-surgical patients in Singapore. In addition, we aim to investigate the association between preoperative anemia, RDW and MCV levels with one-year mortality after surgery.MethodsRetrospective review of 97,443 patients aged > = 18 years who underwent cardiac and non-cardiac surgeries under anesthesia between January 2012 and October 2016. Patient demographics, comorbidities, priority of surgery, surgical risk classification, perioperative transfusion, preoperative hemoglobin, RDW, MCV were collected. WHO anemia classification was used. High RDW was defined as >15.7%. Multivariate regression analyses were done to identify independent risk factors for mild or moderate/severe anemia and high RDW (>15.7). Multivariate cox regression analysis was done to determine the effect of preoperative anemia, abnormal RDW and MCV values on 1-year mortality.ResultsOur cohort comprised of 94.7% non-cardiac and 5.3% cardiac surgeries. 88.7% of patients achieved 1 year follow-up. Anemia prevalence was 27.8%—mild anemia 15.3%, moderate anemia 12.0% and severe anemia 0.5%. One-year mortality was 3.5%. Anemia increased with age in males, while in females, anemia was more prevalent between 18–49 years and > = 70 years. Most anemics were normocytic. Normocytosis and macrocytosis increased with age, while microcytosis decreased with age. Older age, male gender, higher ASA-PS score, anemia (mild- aHR 1.98; moderate/severe aHR 2.86), macrocytosis (aHR 1.47), high RDW (aHR 2.34), moderate-high risk surgery and emergency surgery were associated with higher hazard ratios of one-year mortality.DiscussionPreoperative anemia is common. Anemia, macrocytosis and high RDW increases one year mortality.

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“…The RDW is a measure of variability of red blood cell volume, that is routinely examined with the complete blood count and it represents quantitative measure of anisocytosis. An elevated RDW in peripheral blood may be associated with different types of anemias, as well as certain liver disorders and systemic inflammation [ 14 ]. Additionally, elevated RDW has also been reported as a predictor of adverse outcomes in patients with myocardial infarction, venous thromboembolism, ischemic stroke and cerebral infarction over a past few years [ 14 – 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…An elevated RDW in peripheral blood may be associated with different types of anemias, as well as certain liver disorders and systemic inflammation [ 14 ]. Additionally, elevated RDW has also been reported as a predictor of adverse outcomes in patients with myocardial infarction, venous thromboembolism, ischemic stroke and cerebral infarction over a past few years [ 14 – 17 ]. However, recent studies showed that RDW increased in patients with malignant tumors.…”

Section: Discussionmentioning

confidence: 99%

Elevated red blood cell distribution width predicts poor prognosis in hilar cholangiocarcinoma

You

Xiong

et al. 2017

Oncotarget

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BackgroundAlthough the red blood cell distribution width (RDW) has been reported as a reliable predictor of prognosis in several types of cancer, the prognostic value of RDW in hilar cholangiocarcinoma (HC) has not been studied.MethodsA retrospective analysis of 292 consecutively recruited HC patients undergoing radical resection was conducted. The optimal cutoff value of RDW was determined by the receiver operating characteristic curve (ROC). Survival analysis by the Kaplan-Meier method, the difference between the clinico-pathologic variables and survival were evaluated by log-rank analysis. Multivariate analysis identified independent prognostic risk factors of overall survival (OS).ResultsROC analysis suggested that the optimal cutoff value for the RDW was 14.95. Linear correlation analysis revealed that RDW is associated with white blood cell count (P = 0.007), neutrophil-to-lymphocyte ratio (P = 0.02), and hemoglobin (P < 0.001), albumin (P < 0.001). In a multivariate analysis, the RDW was an independent prognostic factor for OS (HR = 1.755, 95% CI 1.311-2.349, P < 0.001).ConclusionsElevated RDW may be regarded as an indicator of systemic inflammatory response which might facilitate HC growth and metastasis. Current evidence suggests that RDW may have clinical significance in predicting OS after surgery in HC patients.

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Clinical and prognostic significance of anisocytosis measured as a red cell distribution width in patients with colorectal cancer

Cited by 27 publications

References 27 publications

Prognostic value of red cell distribution width (RDW) in colorectal cancer. Results from a single-center cohort on 591 patients

Prognostic value of red cell distribution width (RDW) in colorectal cancer. Results from a single-center cohort on 591 patients

Prevalence of preoperative anemia, abnormal mean corpuscular volume and red cell distribution width among surgical patients in Singapore, and their influence on one year mortality

Elevated red blood cell distribution width predicts poor prognosis in hilar cholangiocarcinoma

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