Skip to main content
SpringerLink
Log in

Evaluation of the prognostic utility of the hemoglobin-to-red cell distribution width ratio in head and neck cancer

  • Head & Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Hemoglobin is a known prognostic marker in many cancers, including head and neck cancer (HNC). There is some evidence that the red cell distribution width, which is an index of variation in size of red blood cells (RBCs), might be associated with prognosis as well. Recently, a novel prognostic biomarker has been reported—the ratio of the hemoglobin-to-red cell distribution width (Hb/RDW). Our objective was to evaluate the prognostic utility of the pretreatment Hb/RDW in HNC, controlled with known prognostic indices.

Methods

Retrospective cohort study in a tertiary academic hospital setting. Patients diagnosed with HNC treated with curative-intent surgery were eligible. Metastatic disease was excluded. The variables collected were age, sex, BMI, alcohol/tobacco exposure, performance scores, ACE-27, tumor characteristics, adjuvant treatment, and lab values. The primary endpoints were event-free survival (EFS) and overall survival (OS). OS was defined as time from start of treatment to death from any cause, and EFS was defined as time from start of treatment to any progression, recurrence, or death from any cause. Univariate and multivariate survival analysis was performed on the primary endpoints.

Results

A total of 205 patients were enrolled from 2010 to 2016. In multivariate analysis, the factors independently associated with EFS were BMI (p = 0.0364), advanced T stage (p = 0.001), and low Hb/RDW ratio (p = 0.017). The factors independently associated with OS were ECOG score (p = 0.042), advanced T stage (p < 0.0001), positive nodes (p = 0.0195), and Hemoglobin (0.0134).

Conclusion

A low Hb/RDW ratio was associated with poorer EFS (HR = 2.02, 95% CI 1.13–3.61, p = 0.017), but was not associated with OS. This is the first study reporting the prognostic utility of Hb:RDW in head and neck cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90

    Article  Google Scholar 

  2. Valero C, Pardo L, López M et al (2017) Pretreatment count of peripheral neutrophils, monocytes, and lymphocytes as independent prognostic factor in patients with head and neck cancer. Head Neck 39(2):219–226

    Article  Google Scholar 

  3. Tham T, Bardash Y, Teegala S, Herman SW, Costantino PD (2018) The red cell distribution width as a prognostic indicator in upper aerodigestive tract (UADT) cancer: a systematic review and meta-analysis. Am J Otolaryngol. https://doi.org/10.1016/j.amjoto.2018.04.013

    Article  PubMed  Google Scholar 

  4. Tham T, Olson C, Khaymovich J, Herman SW, Costantino PD (2018) The lymphocyte-to-monocyte ratio as a prognostic indicator in head and neck cancer: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-018-4972-x

    Article  PubMed  Google Scholar 

  5. Tham T, Bardash Y, Herman SW, Costantino PD (2018) Neutrophil-to-lymphocyte ratio as a prognostic indicator in head and neck cancer: a systematic review and meta-analysis. Head Neck. https://doi.org/10.1002/hed.25324

    Article  PubMed  Google Scholar 

  6. Tonelli M, Sacks F, Arnold M et al (2008) Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation 117(2):163–168

    Article  Google Scholar 

  7. Warwick R, Mediratta N, Shackcloth M et al (2013) Preoperative red cell distribution width in patients undergoing pulmonary resections for non-small-cell lung cancer. Eur J Cardiothorac Surg 45(1):108–113

    Article  Google Scholar 

  8. Seretis C, Seretis F, Lagoudianakis E, Gemenetzis G, Salemis NS (2013) Is red cell distribution width a novel biomarker of breast cancer activity? Data from a pilot study. J Clin Med Res 5(2):121

    PubMed  PubMed Central  Google Scholar 

  9. Wang F-M, Xu G, Zhang Y, Ma L-L (2014) Red cell distribution width is associated with presence, stage, and grade in patients with renal cell carcinoma. Dis Markers. https://doi.org/10.1155/2014/860419

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hu L, Li M, Ding Y et al (2017) Prognostic value of RDW in cancers: a systematic review and meta-analysis. Oncotarget 8(9):16027

    PubMed  Google Scholar 

  11. Dubray B, Mosseri V, Brunin F et al (1996) Anemia is associated with lower local-regional control and survival after radiation therapy for head and neck cancer: a prospective study. Radiology 201(2):553–558

    Article  CAS  Google Scholar 

  12. Guo S-S, Tang L-Q, Chen Q-Y et al (2015) Is hemoglobin level in patients with nasopharyngeal carcinoma still a significant prognostic factor in the era of intensity-modulated radiotherapy technology? PLoS One 10(8):e0136033

    Article  Google Scholar 

  13. Cordella C, Luebbers H-T, Rivelli V, Grätz KW, Kruse AL (2011) An evaluation of the preoperative hemoglobin level as a prognostic factor for oral squamous cell carcinoma. Head Neck Oncol 3(1):35

    Article  CAS  Google Scholar 

  14. Ye X, Liu J, Chen Y, Wang N, Lu R (2015) The impact of hemoglobin level and transfusion on the outcomes of chemotherapy in gastric cancer patients. Int J Clin Exp Med 8(3):4228

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Shin N-R, Lee Y-Y, Kim S-H et al (2014) Prognostic value of pretreatment hemoglobin level in patients with early cervical cancer. Obstet Gynecol Sci 57(1):28–36

    Article  Google Scholar 

  16. Zhang F, Han H, Wang C et al (2013) A retrospective study: the prognostic value of anemia, smoking and drinking in esophageal squamous cell carcinoma with primary radiotherapy. World J Surg Oncol 11(1):249

    Article  Google Scholar 

  17. Sun P, Zhang F, Chen C et al (2016) The ratio of hemoglobin to red cell distribution width as a novel prognostic parameter in esophageal squamous cell carcinoma: a retrospective study from southern China. Oncotarget 7(27):42650

    PubMed  PubMed Central  Google Scholar 

  18. Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr (2004) Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 291(20):2441–2447

    Article  CAS  Google Scholar 

  19. Harris PA, Taylor R, Thielke R et al (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381

    Article  Google Scholar 

  20. Michiels S, Le Maître A, Buyse M et al (2009) Surrogate endpoints for overall survival in locally advanced head and neck cancer: meta-analyses of individual patient data. Lancet Oncol 10(4):341–350

    Article  Google Scholar 

  21. Machin D, Campbell MJ, Tan S-B, Tan S-H (2011) Sample size tables for clinical studies. Wiley, Hoboken

    Google Scholar 

  22. Budczies J, Klauschen F, Sinn BV et al (2012) Cutoff Finder: a comprehensive and straightforward Web application enabling rapid biomarker cutoff optimization. PLoS One 7(12):e51862

    Article  CAS  Google Scholar 

  23. van Leeuwen PA, Kuik DJ, Klop WMC et al (1999) The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer 86(3):519–527

    Article  Google Scholar 

  24. Proctor M, Morrison D, Talwar D et al (2011) An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome Study. Br J Cancer 104(4):726

    Article  CAS  Google Scholar 

  25. Sun W, Zhang L, Luo M et al (2016) Pretreatment hematologic markers as prognostic factors in patients with nasopharyngeal carcinoma: neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. Head Neck 38(Suppl 1):E1332–E1340

    Article  Google Scholar 

  26. Khandavilli SD, Ceallaigh P, Lloyd CJ, Whitaker R (2009) Serum C-reactive protein as a prognostic indicator in patients with oral squamous cell carcinoma. Oral Oncol 45(10):912–914

    Article  CAS  Google Scholar 

  27. Compton C (2018) Precision medicine core: progress in prognostication—populations to patients. Ann Surg Oncol 25(2):349–350

    Article  Google Scholar 

Download references

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 130 East 77th Street, 10th Floor, New York, NY, 10075, USA

    Tristan Tham, Caitlin Olson, Michael Wotman, Sireesha Teegala, Julian Khaymovich, Josephine Coury & Peter Costantino

Authors
  1. Tristan Tham
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Caitlin Olson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Wotman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sireesha Teegala
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Julian Khaymovich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Josephine Coury
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter Costantino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tristan Tham.

Ethics declarations

Conflict of interest

The authors have no financial or personal disclosures, or conflicts of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (XLSX 21 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tham, T., Olson, C., Wotman, M. et al. Evaluation of the prognostic utility of the hemoglobin-to-red cell distribution width ratio in head and neck cancer. Eur Arch Otorhinolaryngol 275, 2869–2878 (2018). https://doi.org/10.1007/s00405-018-5144-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-018-5144-8

Keywords

Search

Navigation