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Red Cell Distribution Width as a Predictor of Survival in Patients with Hepatocellular Carcinoma
Gianpaolo Vidili1, Angelo Zinellu2, Arduino Aleksander Mangoni3,4
1Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43a, 07100 Sassari, Italy.
Insights
Red cell distribution width (RDW) effectively predicts survival in hepatocellular carcinoma (HCC) patients. Higher RDW levels are linked to increased mortality, outperforming other blood biomarkers for prognosis.
Area of Science:
- Oncology
- Hematology
- Biomarker Discovery
Background:
- Hepatocellular carcinoma (HCC) and intrahepatic biliary tract cancers are leading causes of cancer mortality worldwide.
- Accurate biomarkers are crucial for risk stratification and prognosis in HCC patients.
- Existing biomarkers for HCC prognosis require improvement.
Purpose of the Study:
- To investigate the predictive ability of red cell distribution width (RDW) for survival in HCC patients.
- To compare RDW's prognostic value against other hematological and biochemical parameters.
- To establish an optimal RDW cut-off for survival prediction in HCC.
Main Methods:
- A consecutive series of 104 HCC patients with histologic diagnosis were included.
- Demographic, clinical, and laboratory data were collected, including RDW.
- Patients were followed for three years to assess survival outcomes.
Main Results:
- Higher RDW values were significantly associated with mortality in both univariate and multivariate analyses.
- The optimal RDW cut-off for survival prediction was 14.7% (sensitivity 65%, specificity 74%, AUC=0.718).
- Patients with RDW > 14.7% had significantly lower survival rates (mean survival 22.3 months vs 30.9 months).
Conclusions:
- RDW is a valuable and independent predictor of prognosis in HCC patients.
- RDW demonstrates superior performance compared to other blood-based biomarkers for HCC survival prediction.
- RDW offers a simple, accessible biomarker for improving HCC patient risk stratification and management.
Abstract:
Background and Objectives. Hepatocellular carcinoma (HCC) and the intrahepatic biliary tract cancers are estimated to rank sixth for incidence among solid cancers worldwide, and third for mortality rates. A critical issue remains the need for accurate biomarkers for risk stratification and overall prognosis. The aim of this study was to investigate the ability of a biomarker of heterogeneity of the size of red blood cells, the red cell distribution width (RDW), to predict survival in patients with HCC. Materials and Methods. A consecutive series of patients with a histologic diagnosis of HCC were included into this study irrespective of their age, stage of the disease, and treatment administered, and followed-up for a period of three years. Demographic, anthropometric [age, sex, body mass index (BMI)], and clinical data (Charlson Comorbidity Index, Child-Pugh score, etc.), along with laboratory tests were retrieved from clinical records. Results. One-hundred and four patients were included in this study. Among them, 54 (69%) were deceased at the end of the follow-up. Higher RDW values, but not other hematological and biochemical parameters, were significantly associated with mortality in both univariate and multivariate analysis. The optimal RDW cut-off value identified with the Youden test for survival was 14.7%, with 65% sensitivity and 74% specificity (AUC = 0.718, 95% CI 0.622-0.802, p < 0.001). Kaplan-Meier survival curves showed significantly lower survival with higher RDW values (HR = 3.5204; 95% CI 1.9680-6.2975, p < 0.0001) with a mean survival of 30.9 ± 9.67 months for patients with RDW ≤ 14.7% and 22.3 ± 11.4 months for patients with RDW > 14.7%. Conclusions. The results of our study showed that RDW can perform better than other blood-based biomarkers in independently predicting prognosis in patients with HCC.
