Pretreatment Circulating Albumin, Platelet, and RDW-SD Associated with Worse Disease-Free Survival in Patients with Breast Cancer

Chia-Chi Chen; Wei-Hua Tang; Cheng-Ching Wu; Thung-Lip Lee; I-Ting Tsai; Chin-Feng Hsuan; Chao-Ping Wang; Fu-Mei Chung; Yau-Jiunn Lee; Teng-Hung Yu; Ching-Ting Wei

doi:10.2147/BCTT.S443292

Pretreatment Circulating Albumin, Platelet, and RDW-SD Associated with Worse Disease-Free Survival in Patients with Breast Cancer

Breast Cancer (Dove Med Press). 2024 Jan 16:16:23-39. doi: 10.2147/BCTT.S443292. eCollection 2024.

Authors

Chia-Chi Chen^{1

2

3

4}, Wei-Hua Tang^{5

6}, Cheng-Ching Wu^{2

7

8}, Thung-Lip Lee^{7

9}, I-Ting Tsai^{2

10}, Chin-Feng Hsuan^{2

7

11}, Chao-Ping Wang^{7

9}, Fu-Mei Chung⁷, Yau-Jiunn Lee¹², Teng-Hung Yu^#^{2

7}, Ching-Ting Wei^#^{4

13}

Affiliations

¹ Department of Pathology, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan.
² School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan.
³ Department of Physical Therapy, I-Shou University, Kaohsiung, 82445, Taiwan.
⁴ The School of Chinese Medicine for Post Baccalaureate, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan.
⁵ Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Yuli Branch, Hualien, 98142, Taiwan.
⁶ Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan.
⁷ Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan.
⁸ Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital, I-Shou, University, Kaohsiung, 82445, Taiwan.
⁹ School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan.
¹⁰ Department of Emergency, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan.
¹¹ Division of Cardiology, Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan.
¹² Lee's Endocrinologic Clinic, Pingtung, 90000, Taiwan.
¹³ Division of General Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan.

^# Contributed equally.

Abstract

Objective: Breast cancer is the second most common malignancy globally and a leading cause of cancer death in women. Analysis of factors related to disease-free survival (DFS) has improved understanding of the disease and characteristics related to recurrence. The aim of this study was to investigate the predictors of DFS in patients with breast cancer to enable the identification of patients at high risk who may benefit from prevention interventions.

Methods: We retrospectively analyzed 559 women with breast cancer who underwent treatment between 2004 and 2022. The study endpoint was DFS. Recurrence was defined as local recurrence, regional recurrence, distant metastases, contralateral breast cancer, other second primary cancer, and death. Baseline tumor-related characteristics, treatment-related characteristics, sociodemographic and biochemical data were analyzed using Cox proportional hazards analysis.

Results: The median DFS was 45 months (range, 2 to 225 months). Breast cancer recurred in 86 patients (15.4%), of whom 10 had local recurrence, 10 had regional recurrence, 17 had contralateral breast cancer, 29 had distant metastases, 10 had second primary cancer, and 10 patients died. Multivariate forward stepwise Cox regression analysis showed that AJCC stage III, Ki67 ≥14%, albumin, platelet, and red cell distribution width-standard deviation (RDW-SD) were predictors of worse DFS. In addition, the effects of albumin, platelet, and RDW-SD on disease recurrence were confirmed by structural equation model (SEM) analysis.

Conclusion: In addition to the traditional predictors of worse DFS such as AJCC stage III and Ki67 ≥14%, lower pretreatment circulating albumin, higher pretreatment circulating platelet count and RDW-SD could significantly predict worse DFS in this study, and SEM delineated possible causal pathways and inter-relationships of albumin, platelet, and RDW-SD contributing to the disease recurrence among Chinese women with breast cancer.

Keywords: RDW-SD; albumin; breast cancer; disease-free survival; platelet.

Grants and funding

E-Da Hospital financially supported this research under Contracts EDAHP111034 and EDAHI111001.