title: Reduced red blood cell count predicts poor survival after surgery in patients with primary liver cancer.
abstract: Currently, the optimal therapy of primary liver cancer (PLC) remains to be hepatic resection. For better management of the patients, we evaluated the prognostic predicting value of red blood cell (RBC) count, a routine laboratory parameter, on the long-term survival of patients who underwent surgical treatment. Clinical and laboratory data of 758 patients, who underwent surgical hepatic resection, were retrospectively studied by χ2 tests and logistic regression. All patients were enrolled at Henan Cancer Hospital, Zhengzhou, China, from February 2009 to July 2013, and none of them received any other treatments before surgery. Kaplan-Meier survival analysis and Cox proportional hazard models were used to examine the influence of RBC counts on patients' survival. The Cox univariate and multivariate analyses showed that preoperative RBC count was an independent risk factor of poor prognosis after surgical treatment. The Kaplan-Meier curves showed that the overall survival (OS) of patients without reduced preoperative RBC counts was significantly better than those patients with reduced preoperative RBC counts (P < 0.001). Concordantly, compared with the patients with either reduced preoperative and/or postoperative RBC counts, patients without reduced RBC counts preferred to be low Child-Pugh grades (P = 0.0065), which implies a better hepatic function. In addition, low RBC count was found to be significantly associated with patients of female (P = 0.003), younger age (P =  < 0.001), and with higher AST/ALT ratio (P = 0.005). This study revealed that patients with preoperative RBC counts lower than normal had worse OS rates than those without reduced preoperative RBC counts, perhaps due to the significant correlation of reduced preoperative RBC count to patients' worse Child-Pugh grade that reflect the loss of liver functions.
authors.affiliation: From the Department of Epidemiology and Biostatistics (XX, KW, FL), College of Public Health, Zhengzhou University, Zhengzhou; Department of Microbiology and Infectious Disease Center (MY, XC, FL), School of Basic Medical Sciences, Peking University Health Science Center, Beijing; Department of Medical Records (WL), Henan Cancer Hospital; Department of Nutrition and Food Hygiene (QL), College of Public Health, Zhengzhou University; and Department of Hepatobiliary Surgery (LZ), Henan Cancer Hospital, Zhengzhou, China.
authors.forename: Xiaomeng
authors.initials: X
authors.lastname: Xie
authors.forename: Mingjie
authors.initials: M
authors.lastname: Yao
authors.forename: Xiangmei
authors.initials: X
authors.lastname: Chen
authors.forename: Weiquan
authors.initials: W
authors.lastname: Lu
authors.forename: Quanjun
authors.initials: Q
authors.lastname: Lv
authors.forename: Kaijuan
authors.initials: K
authors.lastname: Wang
authors.forename: Ling
authors.initials: L
authors.lastname: Zhang
authors.forename: Fengmin
authors.initials: F
authors.lastname: Lu
mesh_terms: D002681:China / Q000453:epidemiology; D004906:Erythrocyte Count; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index