Predictive value of red blood cell distribution width level on histological response and prognosis in colorectal liver metastases

Abstract

Background:The red blood cell distribution width (RDW) level is a potential prognostic factor for solid tumours.We aimed to investigate the predictive value of pre-neoadjuvant chemotherapy (pre-NAC) RDW, preoperative RDW and the change in RDW on the pathological response and prognosis of patients with colorectal liver metastasis (CRLM), which was helpful for treatment decision-making, surveillance and prognostication.Methods: This retrospective study analyzed clinicopathologic data, treatments and outcomes of 150 CRLM patients treated with NAC followed by liver resection at our hospital. The primary outcomes were progression-free survival (PFS) and overall survival (OS). The secondary outcome was postoperative major complications. The RDW level was presented as the RDW-SD level and the RDW-CV level. The optimal cut-off of RDW level was determined by X-tile analysis. The change in RDW was scored as 0 (decreased pre-NAC RDW and decreased preoperative RDW), 2 (elevated pre-NAC RDW and elevated preoperative RDW), or 1 (all other combinations). Multivariable logistic regression analysis was performed to determine the relationships between the tumour characteristics and pathological response and the postoperative major complications. A multivariate Cox proportional hazards model was used to evaluate the prognostic factors associated with survival.Results: The optimal cut-off values of the RDW-CV and RDW-SD levels for survival were 13.5% and 42.2 fl, respectively. The multivariate analysis showed that a preoperative RDW-CV ≥13.5% (OR =3.215, 95% CI: 1.299-7.958, P=0.012) significantly predicted a favorable pathological response. The multivariate analysis revealed that a pre-NAC RDW-CV ≥13.5% (OR =2.462, 95% CI: 1.080-5.615, P=0.032) significantly predicted postoperative major complications. In the multivariate analysis, an RDW-CV change =2 (HR =0.487, 95% CI: 0.309-0.768, P=0.002) was a significant predictor of better PFS. The multivariate analysis also revealed that an RDW-SD change =2 (HR =0.532, 95% CI: 0.332-0.854, P=0.009) were an independent predictor of better OS.Conclusions: This study revealed that pre-NAC RDW, preoperative RDW and RDW changes may be reliable markers that could predict a pathological response and prognosis in CRLM patients receiving NAC followed by liver resection.

The Ratio of Hemoglobin to Red Cell Distribution Width Predicts Pathological Complete Response with Rectal Cancer Treated by Neoadjuvant Chemoradiotherapy

“…[30][31][32] In a recent study, RDW was shown to be a reliable marker that could predict pathological response after neoadjuvant chemotherapy in rectal cancer patients with liver metastasis. [14] The normal reference range of RDW-CV in blood cells is 11.5-15.4%. In our study, the optimal RDW-CV level was determined using ROC analysis to be 15%.…”

“…Among these hematologic parameters, both HB and RDW levels are valuable factors in predicting the pathological response and prognosis in malignancies receiving neoadjuvant therapies, especially in rectal cancer. [13,14] Although HB levels and RDW are successful parameters separately, it may be even more beneficial to combine them. The ratio of hemoglobin to red cell distribution width (HRR) reflects these two parameters simultaneously.…”