Preoperative Routine Laboratory Markers for Predicting Postoperative Recurrence and Death in Patients with Breast Cancer

Abstract

Simple, convenient, and reliable preoperative prognostic indicators are needed to estimate the future risk of recurrences and guide the treatment decisions associated with breast cancer. We evaluated preoperative hematological markers related to recurrence and mortality and investigated independent risk factors for recurrence and mortality in patients after breast cancer surgery. We reviewed electronic medical records of patients with invasive breast cancer diagnosed at our tertiary institution between November 2005 and December 2010 and followed them until 2015. We compared two groups of patients classified according to recurrence or death and identified risk factors for postoperative outcomes. Data from 1783 patients were analyzed ultimately. Cancer antigen (CA) 15-3 and red cell distribution width (RDW) had the highest area under the curve values among several preoperative hematological markers for disease-free survival and overall survival (0.590 and 0.637, respectively). Patients with both preoperative CA 15-3 levels over 11.4 and RDW over 13.5 had a 1.7-fold higher risk of recurrence (hazard ratio (HR): 1.655; 95% confidence interval (CI): 1.154–2.374; p = 0.007) and mortality (HR: 1.723; 95% CI: 1.098–2.704; p = 0.019). In conclusion, relatively high preoperative RDW (>13.5) and CA 15-3 levels (>11.4) had the highest predictive power for mortality and recurrence, respectively. When RDW and CA 15-3 exceeded the cut-off value, the risk of recurrence and death also increased approximately 1.7 times.

Incidence and Risk Factors of Postoperative Complications After Rhinoplasty: A Multi-Institutional ACS-NSQIP Analysis

“…The predictive value of preoperative laboratory values on postoperative results is under intensive research. [16][17][18] We noted that decreased serum albumin and hematocrit levels were significantly associated with the occurrence of complications. Decreased preoperative hematocrit has been shown to correlate with the risk of intraoperative excessive bleeding and the need for blood transfusion.…”

The role of red cell distribution width in predicting the prognosis of patients with breast cancer

“…Breast cancer currently accounts for almost 1 in 3 cancers and is considered the most common cancer worldwide. Most importantly, BC is currently the main cause of cancer-related death in women (18). Although the overall mortality rate from BC decreased by 36% from 1989 to 2012 due to advances in early detection and systemic treatments, to our current knowledge, about 20% of BC patients are diagnosed in advanced stages and experience recurrence or distant metastasis within 5 years (18,21) Therefore, outcome evaluation in patients with BC is very important because it influences treatment decisions.…”

“…In addition to clinicodemographic data, many new hematological prognostic markers have been discovered and defined (19). RDW describes the size variability of circulating red blood cells and has recently gained use as an inflammatory biomarker (18). It has been suggested that RDW is associated with the poor prognosis of different cancer types, such as non-small cell lung cancer, prostate cancer, colorectal cancer, and gastric cancer (22)(23)(24)(25).…”

“…for postoperative mortality and survival (18). RDW elevation has also been shown to be an independent prognostic factor for both OS and disease-free survival (DFS).…”

“…More specifically, RDW is demonstrated to be associated with poor prognosis in various tumor types such as lung cancer, malignant mesothelioma, and multiple myeloma (15)(16)(17). There has been an increase in the number of studies examining possible relationships between the stage and prognosis of BC and RDW, and it has been suggested that RDW has a prognostic value in BC in the majority of these studies (2,(18)(19)(20). However, considering that complete blood count parameters may demonstrate considerable variations based on measurement devices and demographic characteristics, it is clear that more studies are needed to assess the prognostic value of RDW in women with BC.…”