Prognostic significance of red cell distribution width in elderly patients undergoing resection for non-small cell lung cancer.
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.
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Junji
J
Ichinose
Department of Thoracic and Cardiovascular Surgery, Kansai Medical University, Hirakata City, Japan.
Tomohiro
T
Murakawa
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Mitsuaki
M
Kawashima
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Kazuhiro
K
Nagayama
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Jun-Ichi
JI
Nitadori
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Masaki
M
Anraku
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Jun
J
Nakajima
Lung cancer; elderly; red cell distribution width (RDW)