Clinical Significance of Red Cell Distribution Width and Circulating Tumor Cells with an Epithelial-Mesenchymal Transition Phenotype in Lung Adenocarcinoma

Huajian Peng; Xiang Tan; Yongyong Wang; Lei Dai; Guanbiao Liang; Jianji Guo; Mingwu Chen

doi:10.2147/CMAR.S251271

Clinical Significance of Red Cell Distribution Width and Circulating Tumor Cells with an Epithelial-Mesenchymal Transition Phenotype in Lung Adenocarcinoma

Cancer Manag Res. 2020 Jun 26:12:5105-5117. doi: 10.2147/CMAR.S251271. eCollection 2020.

Authors

Huajian Peng^#¹, Xiang Tan^#¹, Yongyong Wang¹, Lei Dai¹, Guanbiao Liang¹, Jianji Guo¹, Mingwu Chen¹

Affiliation

¹ Department of Thoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China.

^# Contributed equally.

Abstract

Objective: To determine the prognostic value of red cell distribution width (RDW) and circulating tumor cells with epithelial-mesenchymal transition phenotype (M-CTC) in lung adenocarcinoma (LUAD).

Patients and methods: Clinical and laboratory data of 60 patients with LUAD were collected. CTCs were isolated from their peripheral blood using the CanPatrol^TM CTC enrichment method. The indicators of RDW and neutrophil lymphocyte ratio (NLR) were calculated based on the laboratory standards.

Results: A total of 60 LUAD patients were enrolled, of which 19 (31.7%) had high RDW (>0.14) and 32 (53.3%) were positive for M-CTCs. There was no significant correlation between RDW and the clinical characteristics. M-CTC was not significantly associated with tumor size and differentiation, age, gender, tumor stage, and histological type but correlated significantly with lymphatic metastasis (P = 0.044), high NLR (>2.26, P = 0.023), and high RDW (>0.14, P = 0.036). Furthermore, the M-CTC⁺ LUAD patients had a significantly poor recurrence-free survival (RFS; Log rank P =0.001, HR = 2.749, 95% CI = 1.489-5.078) and overall survival (OS; Log rank P =0.022, HR = 2.283, 95% CI = 1.128-4.622) compared to the M-CTC^- patients. Similarly, high RDW also correlated with worse RFS (Log rank P = 0.008, HR = 2.331, 95% CI = 1.248-4.353) and OS (Log rank P = 0.004, HR = 0.004, 95% CI = 1.398-5.525).

Conclusion: M-CTC is significantly related to RDW and NLR, and an independent prognostic factor in LUAD.

Keywords: circulating tumor cell; epithelial–mesenchymal; lung adenocarcinoma; red cell distribution width; survival.