J Cancer 2019; 10(18):4305-4317. doi:10.7150/jca.31598


Prognostic role of pretreatment red blood cell distribution width in patients with cancer: A meta-analysis of 49 studies

Peng-Fei Wang1,#, Si-Ying Song2,#, Hang Guo1,3,#, Ting-Jian Wang1, Ning Liu1,✉, Chang-Xiang Yan1,✉

1. Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
2. School of Basic Medical Sciences, Capital Medical University, Beijing, China
3. Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Naval Military Medical University, Shanghai, China
#Peng-fei Wang, Si-ying Song & Hang Guo contributed equally to the work.


Red blood cell distribution width (RDW) has been recently demonstrated to be a predictor of inflammation. High pretreatment RDW level is associated with poor survival outcomes in various malignancies, although the results are controversial. We aimed to investigate the prognostic role of RDW. A systematic literature search was performed in MEDLINE and EMBASE till April 2018. Pooled hazard ratios (HRs) were estimated for overall survival (OS) and combined disease-free survival, progression-free survival, and recurrence-free survival (DFS/PFS/RFS). 49 studies with 19,790 individuals were included in the final analysis. High RDW level adversely affected both OS and DFS/PFS/RFS. For solid cancers, colorectal cancer (CRC) had the strongest relationship with poor OS, followed by hepatic cancer (HCC). Negative OS outcomes were also observed in hematological malignancies. Furthermore, patients at either early or advanced stage had inverse relationship between high pretreatment RDW and poor OS. Studies with cut-off values between 13% and 14% had worse HRs for OS and DFS/PFS/RFS than others. Furthermore, region under the curve (ROC) analysis was used widely to define cut-off values and had relatively closer relationship with poorer HRs. In conclusion, our results suggested that elevated pretreatment RDW level could be a negative predictor for cancer prognosis.

Keywords: red blood cell distribution width, malignancies, prognosis, meta-analysis

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How to cite this article:
Wang PF, Song SY, Guo H, Wang TJ, Liu N, Yan CX. Prognostic role of pretreatment red blood cell distribution width in patients with cancer: A meta-analysis of 49 studies. J Cancer 2019; 10(18):4305-4317. doi:10.7150/jca.31598. Available from http://www.jcancer.org/v10p4305.htm