Prognostic Value of Red Blood Cell Distribution Width (RDW) in the Recurrence of Hepatocellular Carcinoma Following Curative Resection

Mohammad Golriz,1,2 Ali Ramouz,1 Sadeq Ali-Hasan-Al-Saegh,1 Saeed Shafiei,1 Ehsan Aminizadeh,1 Ahmed Hammad,1 Markus Mieth,1 Christian Rupp,2,3 Christoph Springfeld,2,4 Katrin Hoffmann,1,2 Markus Büchler,1 Arianeb Mehrabi1,2 1Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany; 2Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany; 3Department of Internal Medicine IV, Gastroenterology & Hepatology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany; 4National Center for Tumor Diseases, Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, GermanyCorrespondence: Arianeb Mehrabi, Head of the Division of Liver Surgery and Visceral Transplantation, Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, Heidelberg, 69120, Germany, Tel +49– 6221– 5636223, Fax +49– 6221– 567470, Email arianeb.mehrabi@med.uni-heidelberg.dePurpose: Although surgery is associated with an acceptable cure rate, tumor recurrence is still a challenging issue in hepatocellular carcinoma (HCC) patients. Red blood cell distribution width (RDW) is considered an inflammatory marker for predicting overall mortality in a wide spectrum of malignancies. In the current study, the prognostic role of pre- and postoperative RDW in HCC recurrence after liver resection (LRx) is investigated.Patients and Methods: In 395 patients, RDW levels were evaluated preoperatively as well as six and twelve months after curative LRx. The RDW cutoff values were determined using receiver operating characteristic curves (ROCs) according to the recurrence-free survival (RFS). Survival analyses were performed using the Kaplan–Meier, and differences were compared using the Log rank test.Results: The RFS was significantly higher among patients with low RDW at the 6th month and 12th month, postoperatively (P < 0.001 and P = 0.028). RDW levels of higher than 16.15% at the 6th (HR: 2.047, P < 0.001) and higher than 15.85% at 12th (HR: 3.105, P < 0.002) months after liver resection were independent predictors of RFS.Conclusion: Postoperative RDW values seem to be predictive of tumor recurrence in HCC patients. RDW levels at the 6th and 12th months postoperatively were independent predictors of recurrence after LRx.Keywords: hepatectomy, hepatocellular carcinoma, liver resection, red blood cell distribution width