Can Red Blood Cell Distribution Width Predict Laryngectomy Complications or Survival Outcomes?

Abstract

Objective: Red blood cell distribution width (RDW), a reported biomarker for morbidity and mortality in chronic disease and following certain surgeries, has not been well-studied in head and neck cancer patients. The aim of the study was to examine the association of RDW with postoperative complications and survival among patients who underwent primary or salvage laryngectomy. Methods: We analyzed a retrospective case series study of patients diagnosed with squamous cell carcinoma of the larynx treated with total laryngectomy. Survival outcomes were examined using Kaplan-Meier analysis. Results: One hundred seventy-seven patients were included in the final analysis. The most common tumor subsite was the supraglottis (60%). On bivariate analysis, patients with RDW ≥14.5 had higher prevalence of non-surgical, systemic complications, including deep venous thrombosis, pneumonia, cardiovascular events, and difficulty weaning from mechanical ventilation. However, there was no significant difference in laryngectomy-specific post-operative complications, including pharyngocutaneous fistula, wound infection, stoma complications, and chyle leak. RDW was not found to be associated with survival outcomes following laryngectomy. Conclusions: Among laryngectomy patients, RDW ≥14.5 is associated with higher prevalence of systemic morbidity, but not with specific local surgical complications or decreased survival.

Red blood cell distribution width (RDW) is a significant predictor of survival in laryngeal cancer patients: Systematic literature review and meta-analysis

“…Thus, it is conceivable that using a higher RDW threshold value, as in all the other studies (i.e., 13.5% or higher), would have enabled to more accurately stratifying the patients. Even in the study by Marcus et al [16] , an enhanced RDW was not associated with decreased survival after laryngectomy. However, it was more commonly seen in patients with systemic complications after laryngectomy.…”

“…Of these, 4 articles ought to be excluded because they did not show sufficient information on RDW values for being included in the pooled analysis, and 3 because they failed to report RDW data in patients with laryngeal cancer. Thus, five studies could be finally included in our pooled analysis ( Table 2 ) [12] [13] [14] [15] [16] . All these studies were retrospective in nature; 2 were conducted in Turkey and one each in China, Poland, and USA; 4 studies included laryngeal cancer patients undergoing curative surgery and one undergoing radiotherapy; the cutoff of RDW used in the different studies was comprised between 13.5–14.5%.…”

“…In 2022, Marcus et al [16] reported the results of another retrospective study, including 177 patients with laryngeal squamous cell carcinoma patients undergoing laryngectomy who were followed up for 15 years. The medium- and long-term survival rate at 5 years did not differ significantly between patients with RDW values <14.5% or ≥14.5% (p=0.415 and p=0.950, respectively).…”

Comments Regarding: Marcus K, et al. “Can Red Blood Cell Distribution Width Predict Laryngectomy Complications or Survival Outcomes?” Ann Otol Rhinol Laryngol. 2021 Oct 29;34894211056117. doi: 10.1177/00034894211056117

“…I read with interest the article entitled “Can Red Blood Cell Distribution Width Predict Laryngectomy or Survival Outcomes?” by Marcus et al, 1 which has been recently published by Annals of Otology, Rhinology, and Laryngology . I thank the authors for their potentially impactful addition to the medical literature.…”

“…10 An additional concern is the selection of the cutoff value of 14.5% as being predictive of systemic complications. 1 It is important to readers to recognize that this value was determined by the statistical analysis of the experimental population and may not be accurate for their patient populations. This is a potential problem in any clinical setting in which reference ranges and cutoffs are drawn from the literature and are applied to clinical settings; for this reason, it is recommended that these values be validated by the clinical laboratory before being used to make patient care decisions.…”