The ratio of hemoglobin to red cell distribution width as a novel prognostic parameter in esophageal squamous cell carcinoma: a retrospective study from southern China

Abstract

BackgroundWe propose a novel prognostic parameter for esophageal squamous cell carcinoma (ESCC)—hemoglobin/red cell distribution width (HB/RDW) ratio. Its clinical prognostic value and relationship with other clinicopathological characteristics were investigated in ESCC patients.ResultsThe optimal cut-off value was 0.989 for the HB/RDW ratio. The HB/RDW ratio (P= 0.035), tumor depth (P = 0.020) and lymph node status (P<0.001) were identified to be an independent prognostic factors of OS by multivariate analysis, which was validated by bootstrap resampling. Patients with a low HB/RDW ratio had a 1.416 times greater risk of dying during follow-up compared with those with a high HB/RDW (95% CI = 1.024–1.958, P = 0.035).Materials and MethodsWe retrospectively analyzed 362 patients who underwent curative treatment at a single institution between January 2007 and December 2008. The chi-square test was used to evaluate relationships between the HB/RDW ratio and other clinicopathological variables; the Kaplan–Meier method was used to analyze the 5-year overall survival (OS); and the Cox proportional hazards models were used for univariate and multivariate analyses of variables related to OS.ConclusionA significant association was found between the HB/RDW ratio and clinical characteristics and survival outcomes in ESCC patients. Based on these findings, we believe that the HB/RDW ratio is a novel and promising prognostic parameter for ESCC patients.

Red cell distribution width and cancer

“…However, Zhang et al reported that RDW was no longer associated with either OS or DFS after adjustment for age, lymph node metastasis, TNM stage, adjuvant therapy, smoking status, maximum tumor diameter, MPV, PLT, CA19-9, NLR (Neutrophil-lymphocyte ratio) and COP-MPV (combination of platelet count and MPV). Notably, in the study of Sun (34), while the crude RDW showed no significant association with OS the combination of RDW and HB values in the form of hemoglobin/red blood cell distribution width (HB/RDW) ratio was found independently associated with OS even after adjusting for lymph node status, tumor depth, treatment, tumor size and the Glasgow prognostic score (GPS). Interesting, Hirahara and colleagues (36) found that a high RDW is potentially an independent risk factor for a worse prognosis in non-elderly patients, but not in elderly patients.…”

“…To date, five studies have investigated the prognostic value of RDW in esophageal cancer (34)(35)(36)(37)(38). The study characteristics and the main findings of these studies are reported in Table 2.…”

“…All studies applied similar cut-off values ranging from 12.2% to 15.3% for dividing patients in high and low RDW categories. Unfortunately, only the groups of Sun P. and Chen GP., determined the optimal cut-off value for RDW by receiver operating characteristic (ROC) curves (34,38) while the In univariate analyses RDW always emerged as significant risk factors for a poor prognosis with HR ranging from 1.381 to 3.087 for OS and from 1.719 to 2.332 for CSS. Wan et al (35) and Zhang et al (37) also found a significant association between high RDW and shorter DFS (HR, 3.208; 95% CI, 1.922−5.353; P<0.0001 and 1.474; 95% CI, 1.046−2.077; P=0.027 respectively).…”

Prognostic significance of red blood cell distribution width in gastrointestinal disorders

“…Sun et al[8] proposed to calculate the ratio of hemoglobin (Hb) to RDW ( i.e ., Hb/RDW) as a novel prognostic factor in patients with ESCC. They observed that patients with a Hb/RDW ratio of < 0.989 had a 1.4-time higher risk of death during follow up compared to patients with Hb/RDW ratio > 0.989 (95%CI: 1.024-1.958, P = 0.035)[8].…”

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

“…Based on research related to Hb and RDW in malignant tumors, Sun et al . was the first to report the prognostic value of the baseline Hb‐to‐RDW ratio (HRR) in esophageal squamous cell carcinoma (ESCC) in 2016.…”