Chen Qichen, Mao Rui, Zhao Jianjun, Bi Xinyu, Li Zhiyu, Huang Zhen, Zhang Yefan, Zhou Jianguo, Zhao Hong, Cai Jianqiang
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Palliat Med. 2021 Apr;10(4):4143-4158. doi: 10.21037/apm-20-2418. Epub 2021 Apr 7.
This study aimed to investigate the predictive significance of preoperative red cell volume distribution width (RDW) level for prognosis and to establish nomograms incorporating preoperative blood markers to predict postoperative complications and survival in patients with colorectal liver metastases (CRLM).
This retrospective study included 380 enrolled CRLM patients who underwent hepatic resection. Predictors of postoperative complications were explored using binary logistic regression analysis. Covariates associated with overall survival (OS) and progression-free survival (PFS) were evaluated through univariate and multivariate Cox regression analyses. Only variables that reached statistical significance at P<0.1 in the univariate analysis were allowed to enter the multivariate analyses. The independent predictors that retained in the final multivariate model were incorporated into nomograms.
The optimal cut-off point of preoperative RDW-CV was 16%, and elevated RDW-CV was significantly associated with better prognosis (mPFS: 5.0 vs. 8.9 months, P=0.007; mOS: 59.0 vs. 42.0 months, P=0.041). The optimal cut-off point of preoperative RDW-SD was 43.9 fl, and elevated RDW-SD was significantly associated with worse prognosis (mPFS: 8.0 vs. 13.0 months, P<0.001; mOS:36.8 vs. 70.2 months, P=0.001). A nomogram predicting postoperative complications was constructed based on preoperative gamma-glutamyl transpeptidase (GGT) ≥34.5 U/L, preoperative RDW-CV ≥14.1%, and intraoperative blood loss ≥200.0 mL, with AUROC of 0.658. The calibration curves and Hosmer-Lemeshow test revealed desirable model calibration (chi-square: 3.99, P=0.91). A nomogram predicting PFS was constructed based on preoperative GGT ≥31.0 U/L, preoperative D-dimer ≥0.251 mg/L, preoperative RDW-CV <16.0%, preoperative RDW-SD ≥43.9 fl, positive lymph node metastasis, bilobar liver distribution, and R0 resection with good discrimination (C-index: 0.676±0.016) and calibration. A nomogram for the prediction of OS was constructed with favorable discrimination (C-index: 0.700±0.021) and calibration. Significant differences in PFS and OS were shown among patients stratified into three different risk groups (P<0.001) based on the nomograms.
This study first revealed the relationship between preoperative RDW-SD, RDW-CV, and prognosis in patients with CRLM. It also established nomograms especially considering preoperative blood markers to predict postoperative complications, PFS, and OS, which facilitated physicians to determine the optimal clinical management strategies.
本研究旨在探讨术前红细胞体积分布宽度（RDW）水平对预后的预测意义，并建立包含术前血液标志物的列线图，以预测结直肠癌肝转移（CRLM）患者的术后并发症及生存情况。
本回顾性研究纳入了380例行肝切除术的CRLM患者。采用二元逻辑回归分析探讨术后并发症的预测因素。通过单因素和多因素Cox回归分析评估与总生存期（OS）和无进展生存期（PFS）相关的协变量。单因素分析中P<0.1且具有统计学意义的变量才允许纳入多因素分析。最终多因素模型中保留的独立预测因素被纳入列线图。
术前RDW-CV的最佳截断点为16%，RDW-CV升高与较好的预后显著相关（中位PFS：5.0个月对8.9个月，P=0.007；中位OS：59.0个月对42.0个月，P=0.041）。术前RDW-SD的最佳截断点为43.9 fl，RDW-SD升高与较差的预后显著相关（中位PFS：8.0个月对13.0个月，P<0.001；中位OS：36.8个月对70.2个月，P=0.001）。基于术前γ-谷氨酰转肽酶（GGT）≥34.5 U/L、术前RDW-CV≥14.1%和术中失血≥200.0 mL构建了预测术后并发症的列线图，曲线下面积（AUROC）为0.658。校准曲线和Hosmer-Lemeshow检验显示模型校准良好（卡方值：3.99，P=0.91）。基于术前GGT≥31.0 U/L、术前D-二聚体≥0.251 mg/L、术前RDW-CV<16.0%、术前RDW-SD≥43.9 fl、阳性淋巴结转移、双叶肝分布和R0切除构建了预测PFS的列线图，具有良好的区分度（C指数：0.676±0.016）和校准度。构建了预测OS的列线图，具有良好的区分度（C指数：0.700±0.021）和校准度。根据列线图将患者分为三个不同风险组，PFS和OS存在显著差异（P<0.001）。
本研究首次揭示了术前RDW-SD、RDW-CV与CRLM患者预后之间的关系。还建立了特别考虑术前血液标志物的列线图，以预测术后并发症、PFS和OS，这有助于医生确定最佳的临床管理策略。
