Clinical significance of an increased red blood cell distribution width in patients with rectal cancer undergoing chemor
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ORIGINAL ARTICLE
Clinical significance of an increased red blood cell distribution width in patients with rectal cancer undergoing chemoradiotherapy followed by surgery Shozo Ide1 · Yuji Toiyama1 · Yoshinaga Okugawa1 · Yusuke Omura1 · Takahito Kitajima1 · Hiroyuki Fujikawa1 · Junichiro Hiro1 · Masaki Ohi1 · Masato Kusunoki1 Received: 16 July 2019 / Accepted: 6 November 2019 © Springer Nature Singapore Pte Ltd. 2019
Abstract Purpose The clinical significance of the red blood cell distribution width (RDW) in patients with rectal cancer undergoing preoperative chemoradiotherapy (CRT) followed by surgery has not been fully evaluated. Methods In this retrospective study, we investigated the association between the RDW and the prognosis in 120 patients with locally advanced rectal cancer (LARC). We also performed a subgroup analysis limited to patients with pathological TNM stage I–II (ypN[−]) LARC. Results The RDW standard deviation was used to evaluate the RDW. We set 47.1% as the cut-off value of the RDW for the assessment of the prognosis. The RDW exhibited a significant negative relationship with the serum hemoglobin and albumin levels. An elevated RDW was an independent prognostic factor for the overall survival (OS) and disease-free survival (DFS) in patients with LARC. In addition, an elevated RDW predicted a poor OS and DFS in patients with pathological TNM stage I–II (ypN[−]) LARC. Conclusions The RDW is a promising predictor of a poor survival and recurrence in patients with LARC treated by CRT. Keywords Chemoradiotherapy · Inflammation · Prognosis · Rectal neoplasms · Red blood cell distribution width
Introduction In Japan, colorectal cancer has the highest incidence among all cancers and is the second-most common cause of cancerrelated death. Rectal cancer is associated with colorectal cancer in approximately 30% of patients and results in poor clinical outcomes [1]. This is because patients with locally advanced rectal cancer (LARC) are prone to develop postoperative local recurrence. In the past few decades, preoperative chemoradiotherapy (CRT) followed by curative surgery, including total Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00595-019-01933-3) contains supplementary material, which is available to authorized users. * Yuji Toiyama [email protected]‑u.ac.jp 1
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, 2‑174 Edobashi, Tsu, Mie 514‑8507, Japan
mesorectal excision (TME), has frequently been performed in Western countries. Several studies have shown that CRT combined with TME greatly reduced the local recurrence rate and improved the sphincter preservation rate [2–4]. However, postoperative distant metastasis following TME with CRT still occurs in about 25% of patients and is associated with a poor prognosis [5]. Thus, parameters that will be helpful in the management of these patients must be identified. Postoperative histopathological features, such as the surgical margin (
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