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Prognostic Implications of Red Blood Cell Distribution Width to Albumin Ratio in Myelofibrosis: A 10-Year Multicenter
Tian Zeng1, Zhikang Zheng1,2, Honglan Qian3
1Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.
Introduction:
Myelofibrosis (MF) is a rare myeloproliferative neoplasm (MPN) characterized by significant mortality and limited predictive biomarkers. The red cell distribution width to albumin ratio (RAR), a novel biomarker indicative of inflammation, has emerged as a strong prognostic indicator in the general population but remains unexplored in MF.
Methods:
We retrospectively enrolled 504 consecutive MF patients from 7 hematological centers over a 10-year period. Multivariate Cox regressions were performed to assess the prognostic value of the RAR. Kaplan-Meier and restricted cubic splines (RCS) analyses were further performed to examine the associations between RAR and outcomes. Interaction and subgroup analyses were conducted to explore potential effect modifiers. We developed a predictive nomogram combining RAR and DIPSS-plus, with its incremental improvements assessed by discrimination and calibration metrics.
Results:
Patients who experienced leukemic transformation and death had significantly higher RAR levels. RAR remained an independent predictor of poor survival (adjusted HR: 1.58, 95% CI: 1.36-1.85). RCS further suggested a positive non-linear association between RAR and overall survival. Adding RAR to DIPSS-plus score significantly improved prediction accuracy, as shown by an increased C-index from 0.709 to 0.762, a net reclassification improvement (31.1%, p = 0.004), and an integrated discrimination improvement (6.80%, p < 0.001). The refined model also demonstrated a significantly improved goodness of fit, as evidenced by a likelihood ratio test (p < 0.001) and reductions in AIC and BIC values.
Conclusion:
This large, multi-center cohort study is the first to reveal the prognostic significance of RAR in MF. The modified predictive nomogram combining DIPSS-plus score and RAR enhances prognostic discrimination and calibration, providing a simple yet cost-effective tool for refined risk stratification, especially in resource-limited settings.
Insights
The red cell distribution width to albumin ratio (RAR) is a significant predictor of poor survival in myelofibrosis (MF). Incorporating RAR into the DIPSS-plus score improves prognostic accuracy for MF patients.
Area of Science:
- Hematology
- Oncology
- Neoplastic Diseases
Background:
- Myelofibrosis (MF) is a rare myeloproliferative neoplasm (MPN) with high mortality and limited prognostic biomarkers.
- The red cell distribution width to albumin ratio (RAR) is a novel inflammation marker with prognostic value in general populations, but its role in MF is unknown.
Purpose of the Study:
- To investigate the prognostic significance of the red cell distribution width to albumin ratio (RAR) in myelofibrosis (MF).
- To evaluate the added value of RAR in combination with the DIPSS-plus score for risk stratification in MF.
Main Methods:
- Retrospective analysis of 504 MF patients from 7 hematological centers over 10 years.
- Multivariate Cox regression, Kaplan-Meier, and restricted cubic splines (RCS) analyses were used to assess RAR's prognostic value.
- A predictive nomogram combining RAR and DIPSS-plus was developed and validated.
Main Results:
- Higher RAR levels were associated with leukemic transformation and death in MF patients.
- RAR independently predicted poor survival (adjusted HR: 1.58) and showed a non-linear association with overall survival.
- Adding RAR to DIPSS-plus significantly improved prediction accuracy (C-index increased from 0.709 to 0.762) and model fit.
Conclusions:
- This multi-center study is the first to demonstrate the prognostic significance of RAR in MF.
- A modified nomogram integrating RAR and DIPSS-plus enhances prognostic discrimination and calibration.
- This combined approach offers a simple, cost-effective tool for refined risk stratification in MF, particularly in resource-limited settings.
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