Published: 2020-06-26

Association between red cell distribution width and tumour stage in patients with resected cancer of the head of the pancreas

Archana Pradeep, Anjana Rameshan, Anjali Nair Krishna Kumar, Leyanna Susan George


Background: Predicting the clinical outcome in pancreatic cancer is often challenging due to the lack of reliable and cost effective prognostic parameters. Red Cell Distribution Width (RDW), an index of the variability in the size of the circulating RBCs has been reported to have prognostic significance in some malignancies. There is a scarcity of literature supporting its relevance in pancreatic cancer. Objective was to study the association between RDW and tumor stage in patients with pancreatic cancer attending a tertiary care hospital in South India and to correlate RDW and survival after surgery for pancreatic cancer.

Methods: Retrospective analysis of prospectively collected digital medical records of 254 pancreatic cancer patients, who had undergone surgery at a tertiary centre between 2002 and 2015. This was supplemented with data obtained from telephone conversations with the patients and/or their next of kin.  

Results: Higher RDW values were associated with advanced tumor stages 84.2% of patients with stage 3 cancer and 92.3% with stage 4 cancer had high RDW values. High values were significantly associated with lower survival. The mean duration of survival for people with normal values was 83 months while that for patients with higher values was significantly lower at 72 months.  

Conclusions: There appears to be a significant association between RDW and tumor stage in pancreatic cancer. RDW also correlates with the duration of survival in pancreatic cancer patients. Thus, it may be useful in predicting the clinical outcome in pancreatic cancer.



CA head of pancreas, RDW, Tumour staging

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Michaud DS. Epidemiology of Pancreatic Cancer. Avaialble at https:// link. springer. com/ chapter/ 10.1007%2F978-3-319-35153-7_25. Accessed on 12 March 2020.

Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012 v1. Available at https:// publications. Databases/ Iarc- Cancerbases/ GLOBOCAN-2012-Estimated-Cancer-Incidence-Mortality-And-Prevalence-Worldwide-In-2012-V1.0-2012. Accessed on 04 March 2016.

Wu Z, Kuntz A, Wadleigh RG. CA 19-9 tumor marker: is it reliable? A case report in a patient with pancreatic cancer. Clin Adv Hematol Oncol. 2013;11:50-2.

Howaizi M, Abboura M, Krespine C, Idrissi MS, Marty O, Sobhani DM. A new cause for CA19.9 elevation: heavy tea consumption. Gut. 2003;52:913-4.

Locker GY, Hamilton S, Harris J. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol. 2006;24:5313-27.

Ye Z, Smith C, Kullo IJ. Usefulness of red cell distribution width to predict mortality in patients with peripheral artery disease. Am J Cardiol. 2011;107:1241-5.

Patel KV, Semba RD, Ferrucci L, Newman AB, Fried LP, Wallace RB, et al. Red cell distribution width and mortality in older adults: a meta-analysis. J Gerontol A Biol Sci Med Sci. 2010;65:258-65.

Koma Y, Onishi A, Matsuoka H, Oda N, Yokota N, Matsumoto Y, et al. Increased red blood cell distribution width associates with cancer stage and prognosis in patients with lung cancer. Plos One. 2013;11(8):e80240.

Wang FM, Xu G, Zhang Y, Ma LL. Red cell distribution width is associated with presence, stage, and grade in patients with renal cell carcinoma. Dis Markers. 2014;2014:860419.

Yilmaz A, Malya FU, Ozturk G, Citgez B, Ozdenkaya Y, Ersavas C, et al. Effect of pre-operative red blood cell distribution on cancer stage and morbidity rate in patients with pancreatic cancer. Int J Clin Exp Med. 2014;7(9):3072-5.

Weiss G, Goodnough LT. Anemia chronic disease. N Engl J Med. 2005;35210:1011-23.

Lippi G, Plebani M. Red blood cell distribution width (RDW) and human pathology. One size fits all. Clin Chem Lab Med. 2014;52:1247-9.

Neote K, Darbonne W, Ogez J. Identification of a promiscuous inflammatory peptide receptor on the surface of red blood cells. J Biol Chem. 1993;268:12247-9.

Forhecz Z, Gombos T, Borgulya G. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. J Am Heart Assoc. 2009;158:659-66.

Podhorecka M, Halicka D, Szymczyk A, Macheta A, Chocholska S, Hus M, et al. Assessment of red blood cell distribution width as a prognostic marker in chronic lymphocytic leukemia. Oncotarget. 2016;7:32846-53.

Lisha Ai, Shidai Mu, Yu H. Prognostic role of RDW in hematological malignancies: a systematic review and meta-analysis. Cancer Cell Int. 2018;18:61.

Rhodes CJ, Howard LS, Busbridge M, Ashby D, Kondili E, Gibbs JS, et al. Iron deficiency and raised hepcidin in idiopathic pulmonary arterial hypertension: clinical prevalence, outcomes, and mechanistic insights. J Am Coll Cardiol. 2011;58:300-9.

Calvo GD, Delgado LB, Gonzalez RS, Macia GM, Suarez FM, Solano JJ, et al. Interleukin 6, soluble tumor necrosis factor receptor I and red blood cell distribution width as biological markers of functional dependence in an elderly population: a translational approach. Cytokine. 2012;58:193-8.

Hoffmann JJ, Nabbe KC, Broek NM. Effect of age and gender on reference intervals of red blood cell distribution width (RDW) and mean red cell volume (MCV). Clin Chem Lab Med. 2015;53(12):2015-9.

Kim I, Kim CH, Yim YS, Ahn YS. Autocrine function of erythropoietin in IGF-1-induced erythropoietin biosynthesis. Neuroreport. 2008;9:1699-703.

Kling PJ, Taing KM, Dvorak B, Woodward SS, Philipps AF. Insulin-like growth factor-I stimulates erythropoiesis when administered enterally. Growth Factors. 2006;24:218-23.