Prognostic significance of red cell distribution width in elderly patients undergoing resection for non-small cell lung cancer

Abstract

Background:The impact of red cell distribution width (RDW) on outcomes in elderly patients after surgery for non-small cell lung cancer (NSCLC) is not fully understood. Methods: We retrospectively analyzed 992 NSCLC patients who underwent curative resection between 1998 and 2012. The following variables were included in the analyses to evaluate the role of RDW: age, gender, smoking index, leukocyte count, neutrophil to lymphocyte ratio (NLR), hemoglobin, platelet count, albumin, C-reactive protein, carcinoembryonic antigen, respiratory function, histology, T factor, N factor, surgical approach, surgical procedures, complications and prognosis. Results: High RDW (>13.8) was an independent risk factor for morbidity [hazard ratio (HR) 2.1; P<0.01], recurrence (HR 2.0; P=0.01), overall survival (OS) (HR 2.1; P<0.01) and disease-free survival (DFS) (HR 2.0; P<0.01) in elderly patients (age ≥75 years, n=275), whereas it was not in younger patients (age <75 years, n=717). The surgical outcome was extremely poor in those older than 80 years with a RDW greater than 15% (morbidity, 56%; postoperative stay, 23 days; OS, 24%; DFS, 0%). RDW was unaffected by age (R =0.01; P=0.86) and elevated RDW without anemia was more prognostic than high RDW due to anemia in elderly patients. Conclusions: High RDW was significantly associated with high morbidity and reduced survival in elderly patients who underwent resection for NSCLC. Therefore, this parameter should be taken into account when surgery is considered in the elderly. investigation of the etiology of anemia (1). The volume of erythrocytes is consistent, and RDW is normal in the case of anemia caused by rapid bleeding, whereas the increase of relatively large reticulocytes during the recovery process of anemia raises RDW in the case of slowly progressing anemia. RDW has recently been reported to also be an inflammatory indicator. There is mounting evidence linking elevated RDW and adverse outcomes in cardiac disease (2-4), pulmonary embolism (5), trauma (6), septic shock (7), acute pancreatitis (8), hepatitis (9), stroke (10), dementia (11), metabolic syndrome (12), and respiratory diseases such as non-small cell lung cancer (NSCLC) (13,14), chronic obstructive pulmonary disease (15), interstitial pneumonia (16) and sarcoidosis (17). High RDW has been associated with increased mortality and poor pulmonary function also in the general population (18)(19)(20).The aim of this study was to investigate the prognostic impact of RDW on outcomes in elderly patients after surgery for NSCLC. Methods Patient cohortA total of 1,061 patients with NSCLC who underwent resection at our institute between 1998 and 2012 were retrospectively analyzed. Before the study, the Research Review Board of Tokyo University examined and approved our research protocol in accordance with the Declaration of Helsinki (project approval No. 2406). All patients undergoing surgery irrespective of this study provided written informed consent for the review of their medical charts before the surgery. A total of 69...

Prognostic value of baseline hemoglobin‐to‐red blood cell distribution width ratio in small cell lung cancer: A retrospective analysis

“…Koma et al 35 retrospectively analyzed the data of 332 patients with lung cancer, including 109 women and 223 men who were divided into groups according to RDW values of ≥15% and <15%; the findings of their study confirmed that high levels of RDW are associated with advanced stage disease and indicate poor prognosis in the patients. Similarly, Ichinose et al 22 demonstrated that a high RDW value was significantly associated with increased morbidity and reduced survival in 992 elderly patients who had undergone NSCLC resection.…”

“…Inflammatory response, RDW, and several widely used plasma inflammatory markers, such as C‐reactive protein level, erythrocyte sedimentation rate, and interleukin‐6 level, are positively correlated with each other, and RDW is considered to be an inflammatory marker in patients with cancer. Additionally, malnutrition, which is associated with a deficiency of various minerals and vitamins, such as iron, folic acid, and vitamin B12, as well as low protein levels, has also been linked to elevated RDW levels in patients with cancer. Finally, oxidative stress is related to red blood cell survival and could be a possible mechanism of action of RDW.…”

“…In recent years, changes in RDW have been found to be related to the inflammatory state of the body, which has been shown to affect the development of tumors . Therefore, researchers explored the relationship between RDW and the prognosis of some malignant tumors and confirmed that a high RDW is associated with a poor prognosis, such as in breast cancer, esophageal cancer, non‐small cell lung cancer (NSCLC), SCLC, and other tumors.…”

Low Hematocrit Is a Strong Predictor of Poor Prognosis in Lung Cancer Patients

“…Studies have reported that lung cancer patients with increased peripheral blood leukocytes showed increased mortality [ 3 – 5 ], and the number of lymphocytes and their abnormal functions were also indicators of prognosis [ 4 , 5 ]. HCT is one of the erythrocyte parameters.…”

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

“…There is some evidence that high RDW levels are a negative prognostic indicator for these diseases, and in ammation is the mechanism leading to these high levels [13] . There is increasing evidence that elevated RDW levels are also associated with poor prognosis in a variety of cancers, including hepatocellular carcinoma (HCC) [18][19] , esophageal cancer [20][21] , lung cancer [22] and hematological malignancies [23] . However, a review of the previous related literature shows some research limitations.…”