Increased red blood cell distribution width associates with cancer stage and prognosis in patients with lung cancer.
BACKGROUND
Red cell distribution width (RDW), one of many routinely examined parameters, shows the heterogeneity in erythrocyte size. We investigated the association of RDW levels with clinical parameters and prognosis of lung cancer patients.


METHODS
Clinical and laboratory data from 332 patients with lung cancer in a single institution were retrospectively studied by univariate analysis. Kaplan-Meier survival analysis and Cox proportional hazard models were used to examine the effect of RDW on survival.


RESULTS
THE RDW LEVELS WERE DIVIDED INTO TWO GROUPS: high RDW (>=15%), n=73 vs. low RDW, n=259 (<15%). Univariate analysis showed that there were significant associations of high RDW values with cancer stage, performance status, presence of other disease, white blood cell count, hemoglobin, mean corpuscular volume, platelet count, albumin level, C-reactive protein level, and cytokeratin 19 fragment level. Kruskal-Wallis tests revealed an association of RDW values with cancer stage in patients irrespective of comorbidity (patient with/without comorbidity: p<0.0001, patient without comorbidity: p<0.0001). Stages I-IV lung cancer patients with higher RDW values had poorer prognoses than those with lower RDW values (Wilcoxon test: p=0.002). In particular, the survival rates of stage I and II patients (n=141) were lower in the high RDW group (n=19) than in the low RDW group (n=122) (Wilcoxon test: p<0.001). Moreover, multivariate analysis showed higher RDW is a significant prognostic factor (p=0.040).


CONCLUSIONS
RDW is associated with several factors that reflect inflammation and malnutrition in lung cancer patients. Moreover, high levels of RDW are associated with poor survival. RDW might be used as a new and convenient marker to determine a patient's general condition and to predict the mortality risk of lung cancer patients.
Respiratory Center, Shinko Hospital, Kobe-city, Hyogo, Japan.
Yasuko
Y
Koma
Akira
A
Onishi
Hirofumi
H
Matsuoka
Nao
N
Oda
Naoya
N
Yokota
Yusuke
Y
Matsumoto
Midori
M
Koyama
Nobuhiko
N
Okada
Nariyasu
N
Nakashima
Daiki
D
Masuya
Harukazu
H
Yoshimatsu
Yujiro
Y
Suzuki
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D001792:Blood Platelets / Q000473:pathology; D002097:C-Reactive Protein / Q000378:metabolism; D002277:Carcinoma / Q000097:blood* / Q000145:classification / Q000175:diagnosis / Q000473:pathology; D004909:Erythrocyte Indices; D005260:Female; D006801:Humans; D053539:Keratin-19 / Q000097:blood; D008175:Lung Neoplasms / Q000097:blood* / Q000145:classification / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010976:Platelet Count; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D016019:Survival Analysis
D015415:Biomarkers; D053539:Keratin-19; D012709:Serum Albumin; D002097:C-Reactive Protein