title: Evaluation of the red cell distribution width as a biomarker of early mortality in hepatocellular carcinoma.
abstract: BACKGROUND
  The red cell distribution width is a biomarker of early mortality across various disease states.
  
  
  OBJECTIVE
  To verify whether it may refine estimates of survival in hepatocellular carcinoma.
  
  
  METHODS
  The red cell distribution width measured at diagnosis was analyzed in relationship to mortality by any cause both in a retrospective training cohort (N=208), and in an independent prospectively collected validation cohort (N=106) of patients with hepatocellular carcinoma. Based on Cox proportional hazards modelling, a prognostic index was validated.
  
  
  RESULTS
  In the training and the validation cohort, median survival time was respectively 1026 and 868 days in patients with red cell distribution width ≤14.6%, vs. 282 and 340 days in patients with red cell distribution width >14.6%; the corresponding hazard ratios were 0.43 (95% CI: 0.31-0.60), p<0.0001 and 0.28 (95% CI: 0.17-0.47), p<0.0001. At multivariate analysis, the red cell distribution width remained an independent predictor of survival (p<0.001) in a Cox model including other widely accepted prognostic factors. Applying to the validation dataset the prognostic index derived from the training dataset, the ability of the model to discriminate the survival probabilities of patients was confirmed (Harrell's C=0.769).
  
  
  CONCLUSIONS
  The red cell distribution width is a novel, reproducible, prospectively validated predictor of survival in patients with hepatocellular carcinoma.
authors: Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
authors: Carlo
authors: C
authors: Smirne
authors: Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
authors: Glenda
authors: G
authors: Grossi
authors: Division of Experimental Medicine, Hammersmith Campus of Imperial College London, London, UK.
authors: David J
authors: DJ
authors: Pinato
authors: Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy; CRRF Monsignor Luigi Novarese, Moncrivello, Italy.
authors: Michela E
authors: ME
authors: Burlone
authors: Department of Histopathology, Hammersmith Campus of Imperial College London, London, UK.
authors: Francesco A
authors: FA
authors: Mauri
authors: Department of Oncology, Hammersmith Campus of Imperial College London, London, UK.
authors: Adam
authors: A
authors: Januszewski
authors: Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy.
authors: Alberto
authors: A
authors: Oldani
authors: Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
authors: Rosalba
authors: R
authors: Minisini
authors: Division of Experimental Medicine, Hammersmith Campus of Imperial College London, London, UK.
authors: Rohini
authors: R
authors: Sharma
authors: Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy. Electronic address: mario.pirisi@med.unipmn.it.
authors: Mario
authors: M
authors: Pirisi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D004909:Erythrocyte Indices; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Inflammation; Liver cancer; Prognosis; Red cell distribution width