Evaluation of the red cell distribution width as a biomarker of early mortality in hepatocellular carcinoma

Carlo Smirne, Glenda Grossi, David J. Pinato, Michela E. Burlone, Francesco A. Mauri, Adam Januszewski, Alberto Oldani, Rosalba Minisini, Rohini Sharma, Mario Pirisi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The red cell distribution width is a biomarker of early mortality across various disease states. Aim: To verify whether it may refine estimates of survival in hepatocellular carcinoma. Methods: The red cell distribution width measured at diagnosis was analyzed in relationship to mortality by any cause both in a retrospective training cohort (. N=. 208), and in an independent prospectively collected validation cohort (. N=. 106) of patients with hepatocellular carcinoma. Based on Cox proportional hazards modelling, a prognostic index was validated. Results: In the training and the validation cohort, median survival time was respectively 1026 and 868 days in patients with red cell distribution width ≤14.6%, vs. 282 and 340 days in patients with red cell distribution width >14.6%; the corresponding hazard ratios were 0.43 (95% CI: 0.31-0.60), p<. 0.0001 and 0.28 (95% CI: 0.17-0.47), p<. 0.0001. At multivariate analysis, the red cell distribution width remained an independent predictor of survival (. p<. 0.001) in a Cox model including other widely accepted prognostic factors. Applying to the validation dataset the prognostic index derived from the training dataset, the ability of the model to discriminate the survival probabilities of patients was confirmed (Harrell's C=. 0.769). Conclusions: The red cell distribution width is a novel, reproducible, prospectively validated predictor of survival in patients with hepatocellular carcinoma.

Original languageEnglish
Pages (from-to)488-494
Number of pages7
JournalDigestive and Liver Disease
Volume47
Issue number6
DOIs
Publication statusPublished - 1 Jun 2015

Keywords

  • Inflammation
  • Liver cancer
  • Prognosis
  • Red cell distribution width

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