Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2024; 30(12): 1714-1726
Published online Mar 28, 2024. doi: 10.3748/wjg.v30.i12.1714
Predictive value of red blood cell distribution width and hematocrit for short-term outcomes and prognosis in colorectal cancer patients undergoing radical surgery
Dong Peng, Zi-Wei Li, Fei Liu, Xu-Rui Liu, Chun-Yi Wang
Dong Peng, Zi-Wei Li, Fei Liu, Xu-Rui Liu, Chun-Yi Wang, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Co-first authors: Dong Peng and Zi-Wei Li.
Author contributions: Peng D and Li ZW have contributed equally to this work. Peng D and Li ZW wrote the original draft; all authors contributed to data collection; Peng D and Liu F contributed to the data analysis; Peng D and Liu XR led the quality assessments; Peng D, Li ZW, and Wang CY revised the manuscript; and all authors have agreed on the journal to which the manuscript will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Institutional review board statement: The study was approved by the ethics committee of the First Affiliated Hospital of Chongqing Medical University (2022-K205), this study was conducted in accordance with the World Medical Association Declaration of Helsinki as well.
Informed consent statement: All patients signed informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Yi Wang, MD, PhD, Professor, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China. chunyiwangg@163.com
Received: November 4, 2023
Peer-review started: November 4, 2023
First decision: December 7, 2023
Revised: December 26, 2023
Accepted: March 11, 2024
Article in press: March 11, 2024
Published online: March 28, 2024
Processing time: 145 Days and 3.1 Hours
Abstract
BACKGROUND

Previous studies have reported that low hematocrit levels indicate poor survival in patients with ovarian cancer and cervical cancer, the prognostic value of hematocrit for colorectal cancer (CRC) patients has not been determined. The prognostic value of red blood cell distribution width (RDW) for CRC patients was controversial.

AIM

To investigate the impact of RDW and hematocrit on the short-term outcomes and long-term prognosis of CRC patients who underwent radical surgery.

METHODS

Patients who were diagnosed with CRC and underwent radical CRC resection between January 2011 and January 2020 at a single clinical center were included. The short-term outcomes, overall survival (OS) and disease-free survival (DFS) were compared among the different groups. Cox analysis was also conducted to identify independent risk factors for OS and DFS.

RESULTS

There were 4258 CRC patients who underwent radical surgery included in our study. A total of 1573 patients were in the lower RDW group and 2685 patients were in the higher RDW group. There were 2166 and 2092 patients in the higher hematocrit group and lower hematocrit group, respectively. Patients in the higher RDW group had more intraoperative blood loss (P < 0.01) and more overall complications (P < 0.01) than did those in the lower RDW group. Similarly, patients in the lower hematocrit group had more intraoperative blood loss (P = 0.012), longer hospital stay (P = 0.016) and overall complications (P < 0.01) than did those in the higher hematocrit group. The higher RDW group had a worse OS and DFS than did the lower RDW group for tumor node metastasis (TNM) stage I (OS, P < 0.05; DFS, P = 0.001) and stage II (OS, P = 0.004; DFS, P = 0.01) than the lower RDW group; the lower hematocrit group had worse OS and DFS for TNM stage II (OS, P < 0.05; DFS, P = 0.001) and stage III (OS, P = 0.001; DFS, P = 0.001) than did the higher hematocrit group. Preoperative hematocrit was an independent risk factor for OS [P = 0.017, hazard ratio (HR) = 1.256, 95% confidence interval (CI): 1.041-1.515] and DFS (P = 0.035, HR = 1.194, 95%CI: 1.013-1.408).

CONCLUSION

A higher preoperative RDW and lower hematocrit were associated with more postoperative complications. However, only hematocrit was an independent risk factor for OS and DFS in CRC patients who underwent radical surgery, while RDW was not.

Keywords: Colorectal cancer; Red blood cell distribution width; Survival; Short-term outcomes

Core Tip: This was the first study to show that low hematocrit could predict worse overall survival and disease-free survival in colorectal cancer (CRC) patients who underwent radical surgery. This study investigated the association between red blood cell distribution width (RDW) or hematocrit and short-term outcomes in CRC patients, which has rarely been reported previously. In conclusion, a preoperative higher RDW and lower hematocrit were associated with more postoperative complications.