Preoperatively elevated RDW-SD and RDW-CV predict favorable survival in intrahepatic cholangiocarcinoma patients after curative resection

Abstract

Background: Red blood cell distribution width (RDW) is a parameter reported in blood routine examination, recent studies suggest it was a prognostic factor in various types of cancer patients, although the results are controversial. The objective of this study was to investigate the significance of RDW in patients with Intrahepatic cholangiocarcinoma (ICC) after radical resection. Method:The relationship between the preoperative serum RDW value and clinic pathological characteristics was analyzed in 157 ICC patients between January 2012 and June 2018 who underwent curative resection. X-tile software was used to determine 40.2 fl, 12.6 % as the optimal cut-off value for RDW-SD and RDW-CV respectively. 153 patients were classified into the low RDW-SD (≤ 40.2, n = 53) group and the high RDW-SD (> 40.2, n = 104) group, low RDW-CV (≤ 12.6, n = 94) group and the high RDW-CV (> 12.6, n = 63). Based on the RDW-SD combined with RDW-CV(SCC), classified into SCC = 0 (n = 46), 1 (n = 55) and 2 (n = 56) group. Kaplan-Meier survival analysis and Cox proportional hazard models were used to examine the effect of RDW on survival.Results: Kaplan-Meier curve analysis showed that Patients with RDW-SD > 40.2 were significantly associated with better OS (P = 0.004, median OS: 68.0 months versus 17.0 months). Patients with RDW-CV > 12.6 were significantly associated with better OS (P = 0.030, median OS: not reach versus 22.0 months). Compared with a SCC = 0 or SCC = 1, SCC = 2 was significantly associated with better OS (P < 0.001, median OS: not reach versus 33.0 months versus 16, respectively). In the multivariate analysis, RDW-SD > 40.2 fl (HR = 0.446, 95% CI: 0.262-0.760, P = 0.003), RDW-CV > 12.6 % (HR = 0.425, 95%CI: 0.230-0.783, P = 0.006), SCC = 2 (HR = 0.270, 95%CI: 0.133-0.549, P < 0.001) were associated with favorable OS. The multivariate analysis showed RDW-SD, RDW-CV and SCC level were not independent prognostic factors for PFS. Conclusions:Preoperative RDW is a convenient and easy to collect blood routine examination index, and preoperative low levels of RDW are associated with poor survival in ICC after curative resection.This provides a new way for predicting the prognosis of ICC patients and more targeted intervention measures.We gratefully acknowledge all staff members Authors' contributions XL and QC are the main authors of manuscript and have made substantial contributions to the conception and design of study. XB, JZ, ZL, JZ, ZH, YZ and RM have been involved in collection and analysis of the data, HZ and JC gave final approval and revised of the manuscript. All authors read and approved the final manuscript. Ethics approval and consent to participate