The prognostic roles of red blood cell-associated indicators in patients with resectable gastric cancers

Meng-Ting Cui; Zhan-Wen Liang; Yi-Zhang Sun; Jing Wu; Hong Lu; Wen-Jie Wang; Meng-Dan Xu; Min Jiang; Wei Li; Jun Qian; Wei-Ming Duan

doi:10.21037/tcr.2020.03.46

The prognostic roles of red blood cell-associated indicators in patients with resectable gastric cancers

Transl Cancer Res. 2020 Apr;9(4):2300-2311. doi: 10.21037/tcr.2020.03.46.

Authors

Meng-Ting Cui^#^{1

2}, Zhan-Wen Liang^#¹, Yi-Zhang Sun^#^{1

3}, Jing Wu^{1

4}, Hong Lu^{5

6}, Wen-Jie Wang⁷, Meng-Dan Xu¹, Min Jiang¹, Wei Li^{1

8}, Jun Qian^{9

10}, Wei-Ming Duan¹

Affiliations

¹ Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
² Department of Oncology, Zhangjiagang No.1 People's Hospital, Suzhou 215600, China.
³ School of Clinical Medicine, Jining Medical University, Jining 272000, China.
⁴ Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
⁵ Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
⁶ Department of Oncology, Changshu No.1 People's Hospital, Suzhou 215500, China.
⁷ Department of Radio-Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215001, China.
⁸ Comprehensive Cancer Center, Suzhou Xiangcheng People's Hospital, Suzhou 215000, China.
⁹ Department of Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215001, China.
¹⁰ Suzhou Cancer Medical Center, Suzhou Municipal Hospital, Suzhou 215001, China.

^# Contributed equally.

Abstract

Background: Gastric cancer (GC) is one of the leading causes of cancer-related death worldwide. This study was designed to investigate the prognostic values of red blood cell (RBC)-associated indicators, including RBC, hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and RBC distribution width (RDW) in resectable GC patients.

Methods: In this retrospective study, a total of 104 pathologically confirmed GC patients were recruited. These cases were divided into two groups according to the median values of pretreatment RBC, HGB, HCT, MCV, MCH, MCHC, or RDW. To evaluate the changes in RBC-associated indicators values after treatment, we introduced the concept of post-/pre-treatment ratios (≤1 suggested RBC, HGB, HCT, MCV, MCH, MCHC, or RDW values were not increased after therapy, while >1 represented those in increased levels).

Results: The lower pretreatment MCHC levels were correlated with worse overall survival (OS), while pretreatment levels of RBC, HGB, HCT, MCV, MCH, or RDW were not. The whole course of treatment (surgery plus adjuvant chemotherapy) significantly decreased the values of MCHC, and increased the values of MCV and RDW, whereas it had no obvious effects on the values of RBC, HGB, HCT, or MCH. Patients with post-/pre-treatment MCV ratio >1 had an increased survival ratio. Meanwhile, post-/pre-treatment RBC, HGB, HCT, MCH, MCHC, or RDW ratios were not correlated with outcomes. Multivariate Cox regression analysis revealed that the American Joint Committee on Cancer (AJCC) stage (III), and lower pretreatment MCHC levels were independent risk factors affecting OS. The receiver operating characteristic (ROC) curve analysis showed that an MCHC value of 341.98 g/L was the optimal cutoff value for prognosis, with a sensitivity of 58.3% and a specificity of 75.0%.

Conclusions: Pretreatment MCHC levels could become a potential prognostic factor for resectable GC.

Keywords: Gastric cancer (GC); prognosis; red blood cell-associated indicators (RBC-associated indicators).