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Reduced red blood cell count predicts poor survival after surgery in patients with primary liver cancer.

Xie X, Yao M, Chen X, Lu W, Lv Q, Wang K, Zhang L, Lu F - Medicine (Baltimore) (2015)

Bottom Line: Concordantly, compared with the patients with either reduced preoperative and/or postoperative RBC counts, patients without reduced RBC counts preferred to be low Child-Pugh grades (Pβ€Š=β€Š0.0065), which implies a better hepatic function.In addition, low RBC count was found to be significantly associated with patients of female (Pβ€Š=β€Š0.003), younger age (Pβ€Š=β€Šβ€Š<β€Š0.001), and with higher AST/ALT ratio (Pβ€Š=β€Š0.005).This study revealed that patients with preoperative RBC counts lower than normal had worse OS rates than those without reduced preoperative RBC counts, perhaps due to the significant correlation of reduced preoperative RBC count to patients' worse Child-Pugh grade that reflect the loss of liver functions.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Epidemiology and Biostatistics (XX, KW, FL), College of Public Health, Zhengzhou University, Zhengzhou; Department of Microbiology and Infectious Disease Center (MY, XC, FL), School of Basic Medical Sciences, Peking University Health Science Center, Beijing; Department of Medical Records (WL), Henan Cancer Hospital; Department of Nutrition and Food Hygiene (QL), College of Public Health, Zhengzhou University; and Department of Hepatobiliary Surgery (LZ), Henan Cancer Hospital, Zhengzhou, China.

ABSTRACT
Currently, the optimal therapy of primary liver cancer (PLC) remains to be hepatic resection. For better management of the patients, we evaluated the prognostic predicting value of red blood cell (RBC) count, a routine laboratory parameter, on the long-term survival of patients who underwent surgical treatment. Clinical and laboratory data of 758 patients, who underwent surgical hepatic resection, were retrospectively studied by Ο‡2 tests and logistic regression. All patients were enrolled at Henan Cancer Hospital, Zhengzhou, China, from February 2009 to July 2013, and none of them received any other treatments before surgery. Kaplan-Meier survival analysis and Cox proportional hazard models were used to examine the influence of RBC counts on patients' survival. The Cox univariate and multivariate analyses showed that preoperative RBC count was an independent risk factor of poor prognosis after surgical treatment. The Kaplan-Meier curves showed that the overall survival (OS) of patients without reduced preoperative RBC counts was significantly better than those patients with reduced preoperative RBC counts (Pβ€Š<β€Š0.001). Concordantly, compared with the patients with either reduced preoperative and/or postoperative RBC counts, patients without reduced RBC counts preferred to be low Child-Pugh grades (Pβ€Š=β€Š0.0065), which implies a better hepatic function. In addition, low RBC count was found to be significantly associated with patients of female (Pβ€Š=β€Š0.003), younger age (Pβ€Š=β€Šβ€Š<β€Š0.001), and with higher AST/ALT ratio (Pβ€Š=β€Š0.005). This study revealed that patients with preoperative RBC counts lower than normal had worse OS rates than those without reduced preoperative RBC counts, perhaps due to the significant correlation of reduced preoperative RBC count to patients' worse Child-Pugh grade that reflect the loss of liver functions.

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Comparison of overall survival between patients with high RBC counts and patients with low RBC counts. (A) Patients with high RBC counts (group 1, RBC β‰₯ 4β€ŠΓ—1012/L for male, β‰₯3.5β€ŠΓ—1012/L for female, nβ€Š=β€Š458) and patients with low RBC counts (group 2, RBC < 4β€ŠΓ—1012/L for male, <3.5β€ŠΓ—1012/L for female, nβ€Š=β€Š154). Log-rank test: Pβ€Š<β€Š0.001. (B) Male patients with high RBC counts (group 1, nβ€Š=β€Š367) and patients with low RBC counts (group 2, nβ€Š=β€Š132). Log-rank test: Pβ€Š=β€Š0.001. (C) Female patients with high RBC counts (group 1, nβ€Š=β€Š91) and patients with low RBC counts (group 2, nβ€Š=β€Š22). Log-rank test: Pβ€Š=β€Š0.019. (D) Younger patients with high RBC counts (group 1, nβ€Š=β€Š347) and patients with low RBC counts (group 2, nβ€Š=β€Š95). Log-rank test: Pβ€Š=β€Š0.001. (E) Older patients with high RBC counts (group 1, nβ€Š=β€Š111) and patients with low RBC counts (group 2, nβ€Š=β€Š59). Log-rank test: Pβ€Š=β€Š0.010. RBC = red blood cell.
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Figure 1: Comparison of overall survival between patients with high RBC counts and patients with low RBC counts. (A) Patients with high RBC counts (group 1, RBC β‰₯ 4β€ŠΓ—1012/L for male, β‰₯3.5β€ŠΓ—1012/L for female, nβ€Š=β€Š458) and patients with low RBC counts (group 2, RBC < 4β€ŠΓ—1012/L for male, <3.5β€ŠΓ—1012/L for female, nβ€Š=β€Š154). Log-rank test: Pβ€Š<β€Š0.001. (B) Male patients with high RBC counts (group 1, nβ€Š=β€Š367) and patients with low RBC counts (group 2, nβ€Š=β€Š132). Log-rank test: Pβ€Š=β€Š0.001. (C) Female patients with high RBC counts (group 1, nβ€Š=β€Š91) and patients with low RBC counts (group 2, nβ€Š=β€Š22). Log-rank test: Pβ€Š=β€Š0.019. (D) Younger patients with high RBC counts (group 1, nβ€Š=β€Š347) and patients with low RBC counts (group 2, nβ€Š=β€Š95). Log-rank test: Pβ€Š=β€Š0.001. (E) Older patients with high RBC counts (group 1, nβ€Š=β€Š111) and patients with low RBC counts (group 2, nβ€Š=β€Š59). Log-rank test: Pβ€Š=β€Š0.010. RBC = red blood cell.

Mentions: To the best of our knowledge, this is the first study to report that decreased preoperative RBC count is an independent risk factor of poor prognosis in PLC patients who underwent surgical treatment. This discovery promoted us to evaluate its prognostic predicating value of postoperative survival in PLC patients. Of the 724 patients with available preoperative RBC counts, 612 of them were successfully followed up and enrolled for the OS analysis. Kaplan–Meier curves for OS rate of patients with and without decreased preoperative RBC count were plotted in Figure 1A. The OS of the group 2 patients with decreased preoperative RBC counts was significantly poorer than that of the patients in group 1 (HR: 1.374; 95% confidence interval [CI]: 1.092–1.728; Pβ€Š=β€Š0.007). The 1, 3, and 5-year OS rates of group 2 patients were 31%, 22%, and 19%, respectively. In contrast, the respective OS rates in the group 1 were 52%, 36%, and 26%. In concordance, the median survival time in the group 2 patients was 12.6 months (95% CI: 8.9–16.4), which was significantly <26.6 months (95% CI: 21.2–33.2) of the group 1 patients (Pβ€Š<β€Š0.001).


Reduced red blood cell count predicts poor survival after surgery in patients with primary liver cancer.

Xie X, Yao M, Chen X, Lu W, Lv Q, Wang K, Zhang L, Lu F - Medicine (Baltimore) (2015)

Comparison of overall survival between patients with high RBC counts and patients with low RBC counts. (A) Patients with high RBC counts (group 1, RBC β‰₯ 4β€ŠΓ—1012/L for male, β‰₯3.5β€ŠΓ—1012/L for female, nβ€Š=β€Š458) and patients with low RBC counts (group 2, RBC < 4β€ŠΓ—1012/L for male, <3.5β€ŠΓ—1012/L for female, nβ€Š=β€Š154). Log-rank test: Pβ€Š<β€Š0.001. (B) Male patients with high RBC counts (group 1, nβ€Š=β€Š367) and patients with low RBC counts (group 2, nβ€Š=β€Š132). Log-rank test: Pβ€Š=β€Š0.001. (C) Female patients with high RBC counts (group 1, nβ€Š=β€Š91) and patients with low RBC counts (group 2, nβ€Š=β€Š22). Log-rank test: Pβ€Š=β€Š0.019. (D) Younger patients with high RBC counts (group 1, nβ€Š=β€Š347) and patients with low RBC counts (group 2, nβ€Š=β€Š95). Log-rank test: Pβ€Š=β€Š0.001. (E) Older patients with high RBC counts (group 1, nβ€Š=β€Š111) and patients with low RBC counts (group 2, nβ€Š=β€Š59). Log-rank test: Pβ€Š=β€Š0.010. RBC = red blood cell.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554158&req=5

Figure 1: Comparison of overall survival between patients with high RBC counts and patients with low RBC counts. (A) Patients with high RBC counts (group 1, RBC β‰₯ 4β€ŠΓ—1012/L for male, β‰₯3.5β€ŠΓ—1012/L for female, nβ€Š=β€Š458) and patients with low RBC counts (group 2, RBC < 4β€ŠΓ—1012/L for male, <3.5β€ŠΓ—1012/L for female, nβ€Š=β€Š154). Log-rank test: Pβ€Š<β€Š0.001. (B) Male patients with high RBC counts (group 1, nβ€Š=β€Š367) and patients with low RBC counts (group 2, nβ€Š=β€Š132). Log-rank test: Pβ€Š=β€Š0.001. (C) Female patients with high RBC counts (group 1, nβ€Š=β€Š91) and patients with low RBC counts (group 2, nβ€Š=β€Š22). Log-rank test: Pβ€Š=β€Š0.019. (D) Younger patients with high RBC counts (group 1, nβ€Š=β€Š347) and patients with low RBC counts (group 2, nβ€Š=β€Š95). Log-rank test: Pβ€Š=β€Š0.001. (E) Older patients with high RBC counts (group 1, nβ€Š=β€Š111) and patients with low RBC counts (group 2, nβ€Š=β€Š59). Log-rank test: Pβ€Š=β€Š0.010. RBC = red blood cell.
Mentions: To the best of our knowledge, this is the first study to report that decreased preoperative RBC count is an independent risk factor of poor prognosis in PLC patients who underwent surgical treatment. This discovery promoted us to evaluate its prognostic predicating value of postoperative survival in PLC patients. Of the 724 patients with available preoperative RBC counts, 612 of them were successfully followed up and enrolled for the OS analysis. Kaplan–Meier curves for OS rate of patients with and without decreased preoperative RBC count were plotted in Figure 1A. The OS of the group 2 patients with decreased preoperative RBC counts was significantly poorer than that of the patients in group 1 (HR: 1.374; 95% confidence interval [CI]: 1.092–1.728; Pβ€Š=β€Š0.007). The 1, 3, and 5-year OS rates of group 2 patients were 31%, 22%, and 19%, respectively. In contrast, the respective OS rates in the group 1 were 52%, 36%, and 26%. In concordance, the median survival time in the group 2 patients was 12.6 months (95% CI: 8.9–16.4), which was significantly <26.6 months (95% CI: 21.2–33.2) of the group 1 patients (Pβ€Š<β€Š0.001).

Bottom Line: Concordantly, compared with the patients with either reduced preoperative and/or postoperative RBC counts, patients without reduced RBC counts preferred to be low Child-Pugh grades (Pβ€Š=β€Š0.0065), which implies a better hepatic function.In addition, low RBC count was found to be significantly associated with patients of female (Pβ€Š=β€Š0.003), younger age (Pβ€Š=β€Šβ€Š<β€Š0.001), and with higher AST/ALT ratio (Pβ€Š=β€Š0.005).This study revealed that patients with preoperative RBC counts lower than normal had worse OS rates than those without reduced preoperative RBC counts, perhaps due to the significant correlation of reduced preoperative RBC count to patients' worse Child-Pugh grade that reflect the loss of liver functions.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Epidemiology and Biostatistics (XX, KW, FL), College of Public Health, Zhengzhou University, Zhengzhou; Department of Microbiology and Infectious Disease Center (MY, XC, FL), School of Basic Medical Sciences, Peking University Health Science Center, Beijing; Department of Medical Records (WL), Henan Cancer Hospital; Department of Nutrition and Food Hygiene (QL), College of Public Health, Zhengzhou University; and Department of Hepatobiliary Surgery (LZ), Henan Cancer Hospital, Zhengzhou, China.

ABSTRACT
Currently, the optimal therapy of primary liver cancer (PLC) remains to be hepatic resection. For better management of the patients, we evaluated the prognostic predicting value of red blood cell (RBC) count, a routine laboratory parameter, on the long-term survival of patients who underwent surgical treatment. Clinical and laboratory data of 758 patients, who underwent surgical hepatic resection, were retrospectively studied by Ο‡2 tests and logistic regression. All patients were enrolled at Henan Cancer Hospital, Zhengzhou, China, from February 2009 to July 2013, and none of them received any other treatments before surgery. Kaplan-Meier survival analysis and Cox proportional hazard models were used to examine the influence of RBC counts on patients' survival. The Cox univariate and multivariate analyses showed that preoperative RBC count was an independent risk factor of poor prognosis after surgical treatment. The Kaplan-Meier curves showed that the overall survival (OS) of patients without reduced preoperative RBC counts was significantly better than those patients with reduced preoperative RBC counts (Pβ€Š<β€Š0.001). Concordantly, compared with the patients with either reduced preoperative and/or postoperative RBC counts, patients without reduced RBC counts preferred to be low Child-Pugh grades (Pβ€Š=β€Š0.0065), which implies a better hepatic function. In addition, low RBC count was found to be significantly associated with patients of female (Pβ€Š=β€Š0.003), younger age (Pβ€Š=β€Šβ€Š<β€Š0.001), and with higher AST/ALT ratio (Pβ€Š=β€Š0.005). This study revealed that patients with preoperative RBC counts lower than normal had worse OS rates than those without reduced preoperative RBC counts, perhaps due to the significant correlation of reduced preoperative RBC count to patients' worse Child-Pugh grade that reflect the loss of liver functions.

Show MeSH
Related in: MedlinePlus