Elevated red blood cell distribution width predicts poor prognosis in patients with oral squamous cell carcinoma

Abstract

IntroductionAlthough red blood cell distribution width (RDW) has been reported to reflect inflammation and nutritional status and to predict prognosis in several different types of cancer, little is known about how RDW might be related to oral squamous cell carcinoma (OSCC). The present study aimed to investigate the prognostic value of preoperative RDW in OSCC patients.Materials and methodsWe included 236 OSCC patients from Jinan Stomatological Hospital (Shandong, People’s Republic of China) in this retrospective study. All enrolled patients were divided into 2 groups: high RDW (≥15%) and low RDW (<15%) according to the detected RDW values. The correlation of RDW and clinical characteristics was explored, and the prognostic significance of RDW evaluated using Kaplan–Meier curves, log-rank analysis, and the Cox proportional hazards model.ResultsThe pretreatment median RDW among all OSCC patients was 14.4%, with a range from 11.6% to 24.5%. The RDW was found to be significantly correlated with node metastasis, tumor length, and TNM stage (P<0.05 for all). As for biochemical parameters, the results showed that higher RDW values were significantly associated with hemoglobin, mean corpuscular volume, white blood cell count, albumin, and C-reactive protein (P<0.01 for all). A significant association of RDW with the tumor marker cytokeratin 19 fragments (CYFRA21-1) and squamous cell carcinoma antigen (SCC-Ag) was also observed (P=0.02, and P=0.03; respectively). Moreover, patients with higher RDW were more likely to receive postoperative therapy (P=0.02). Kaplan–Meier survival curves showed that a high RDW was significantly associated with poor overall survival (OS) (P<0.01), especially in the early stages (I–II). Multivariate analysis revealed that an elevated RDW at diagnosis was an independent prognostic factor for shorter OS (HR =1.46, 95% CI: 1.13–2.86) after adjustment for other cancer-related prognostic factors.ConclusionThese data suggest that an elevated preoperative RDW (≥15%) at diagnosis may independently predict poorer OS in patients with OSCC, but better-designed studies in the future should be performed to further confirm the value of monitoring RDW.

Pretreatment Level of Red Cell Distribution Width as a Prognostic Indicator for Survival in a Large Cohort Study of Male Laryngeal Squamous Carcinoma

“…Only five studies have examined the relationship of RDW with cancer in the head and neck region, of which one study was for the thyroid cancer (23), two were for cancers of the oral cavity (24, 25) and two were for laryngeal cancers (14, 26). For thyroid cancer, Aktas et al (23) reported that the level of RDW was significantly higher compared with that in normal subjects.…”

Red cell distribution width as a predictor of late‐onset Gram‐negative sepsis

“…All these conditions are crucial prognostic factors for severe morbidity and mortality . In adults, RDW is a frequently used predictor for monitoring malignancies and inflammatory diseases, such as pancreatitis and hepatitis . However, there are limited studies on the use of RDW in neonates for monitoring patients and determining their prognosis.…”

“…6 In adults, RDW is a frequently used predictor for monitoring malignancies and inflammatory diseases, such as pancreatitis and hepatitis. [18][19][20] However, there are limited studies on the use of RDW in neonates for monitoring patients and determining their prognosis. It has been reported that the increase in RDW in preterm infants may be associated with patent ductus arteriosus, bronchopulmonary dysplasia, and LOS.…”

The role of red cell distribution width as a predictor of bronchopulmonary dysplasia in preterm infants

“…For many years, RDW has been used to monitor many different clinical conditions in adults. Increased RDW has been associated with an increased risk of prognosis and mortality, particularly in cases of acute inflammation, such as coronary syndrome or in chronic inflammatory conditions such as malignancies [7,18] . As a mechanism of the increase in RDW value, it has been indicated that inflammatory cytokines inhibit erythrocyte maturation and induce the release of younger and larger reticulocytes into the circulation and thus alter the distribution of erythrocytes [7,10,18] .…”

“…Increased RDW has been associated with an increased risk of prognosis and mortality, particularly in cases of acute inflammation, such as coronary syndrome or in chronic inflammatory conditions such as malignancies [7,18] . As a mechanism of the increase in RDW value, it has been indicated that inflammatory cytokines inhibit erythrocyte maturation and induce the release of younger and larger reticulocytes into the circulation and thus alter the distribution of erythrocytes [7,10,18] . In recent years after trials realized in adult patients and older children, studies evaluating the relationship between RDW and morbidities and mortality in newborns have been performed [6,11,12,19,20] .…”