Cui Meng-Ting, Liang Zhan-Wen, Sun Yi-Zhang, Wu Jing, Lu Hong, Wang Wen-Jie, Xu Meng-Dan, Jiang Min, Li Wei, Qian Jun, Duan Wei-Ming
Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
Department of Oncology, Zhangjiagang No.1 People's Hospital, Suzhou 215600, China.
Transl Cancer Res. 2020 Apr;9(4):2300-2311. doi: 10.21037/tcr.2020.03.46.
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.
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).
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%.
Pretreatment MCHC levels could become a potential prognostic factor for resectable GC.
胃癌（GC）是全球癌症相关死亡的主要原因之一。本研究旨在探讨红细胞（RBC）相关指标，包括红细胞计数（RBC）、血红蛋白（HGB）、血细胞比容（HCT）、平均红细胞体积（MCV）、平均红细胞血红蛋白含量（MCH）、平均红细胞血红蛋白浓度（MCHC）和红细胞分布宽度（RDW）在可切除胃癌患者中的预后价值。
在这项回顾性研究中，共纳入104例经病理确诊的胃癌患者。根据治疗前RBC、HGB、HCT、MCV、MCH、MCHC或RDW的中位数将这些病例分为两组。为了评估治疗后RBC相关指标值的变化，我们引入了治疗后/治疗前比值的概念（≤1表明治疗后RBC、HGB、HCT、MCV、MCH、MCHC或RDW值未升高，而>1表示这些指标值升高）。
治疗前较低的MCHC水平与较差的总生存期（OS）相关，而治疗前RBC、HGB、HCT、MCV、MCH或RDW水平则无此相关性。整个治疗过程（手术加辅助化疗）显著降低了MCHC值，增加了MCV和RDW值，而对RBC、HGB、HCT或MCH值无明显影响。治疗后/治疗前MCV比值>1的患者生存率增加。同时，治疗后/治疗前RBC、HGB、HCT、MCH、MCHC或RDW比值与预后无关。多因素Cox回归分析显示，美国癌症联合委员会（AJCC）分期（III期）和治疗前较低的MCHC水平是影响OS的独立危险因素。受试者工作特征（ROC）曲线分析表明，MCHC值为341.98 g/L是预后的最佳临界值，敏感性为58.3%，特异性为75.0%。
治疗前MCHC水平可能成为可切除胃癌的潜在预后因素。
