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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 (P = 0.0065), which implies a better hepatic function.In addition, low RBC count was found to be significantly associated with patients of female (P = 0.003), younger age (P =  < 0.001), and with higher AST/ALT ratio (P = 0.005).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 χ2 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 (P < 0.001). 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 (P = 0.0065), which implies a better hepatic function. In addition, low RBC count was found to be significantly associated with patients of female (P = 0.003), younger age (P =  < 0.001), and with higher AST/ALT ratio (P = 0.005). 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 among 4 subgroups (1, 2, 3, 4) of patients. Log-rank test: P < 0.001. Subgroup 1: preoperative and postoperative RBC counts were both high (n = 297). Subgroup 2: preoperative RBC count was high but low postoperation (n = 157). Subgroup 3: preoperative RBC count was low but high postoperation (n = 43). Subgroup 4: preoperative and postoperative RBC counts were both low (n = 109).
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Figure 2: Comparison of overall survival among 4 subgroups (1, 2, 3, 4) of patients. Log-rank test: P < 0.001. Subgroup 1: preoperative and postoperative RBC counts were both high (n = 297). Subgroup 2: preoperative RBC count was high but low postoperation (n = 157). Subgroup 3: preoperative RBC count was low but high postoperation (n = 43). Subgroup 4: preoperative and postoperative RBC counts were both low (n = 109).

Mentions: As preoperative RBC count could potentially be used as a predictor of the OS in PLC patients who underwent surgery, it was worthwhile to take the influence of postoperative RBC count into consideration too. Among the 718 patients with both preoperative and postoperative RBC counts data, 606 of them were successfully followed up. These patients were divided into 4 subgroups according to their preoperative and postoperative levels of RBC counts. Then Kaplan–Meier curve was carried out for OS of each group and the results were plotted in Figure 2. The median OS of the subgroups 1, 2, 3, and 4 were 32.4, 19.2, 17.8, and 11.6 months, respectively. Such differences suggested that patients with both normal preoperative and postoperative RBC counts could expect the best OS, whereas those patients with both decreased preoperative and postoperative RBC counts exhibit the poorest prognosis (P < 0.001). However, no statistically significant difference was found among the subgroups 2, 3, and 4.


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 among 4 subgroups (1, 2, 3, 4) of patients. Log-rank test: P < 0.001. Subgroup 1: preoperative and postoperative RBC counts were both high (n = 297). Subgroup 2: preoperative RBC count was high but low postoperation (n = 157). Subgroup 3: preoperative RBC count was low but high postoperation (n = 43). Subgroup 4: preoperative and postoperative RBC counts were both low (n = 109).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Comparison of overall survival among 4 subgroups (1, 2, 3, 4) of patients. Log-rank test: P < 0.001. Subgroup 1: preoperative and postoperative RBC counts were both high (n = 297). Subgroup 2: preoperative RBC count was high but low postoperation (n = 157). Subgroup 3: preoperative RBC count was low but high postoperation (n = 43). Subgroup 4: preoperative and postoperative RBC counts were both low (n = 109).
Mentions: As preoperative RBC count could potentially be used as a predictor of the OS in PLC patients who underwent surgery, it was worthwhile to take the influence of postoperative RBC count into consideration too. Among the 718 patients with both preoperative and postoperative RBC counts data, 606 of them were successfully followed up. These patients were divided into 4 subgroups according to their preoperative and postoperative levels of RBC counts. Then Kaplan–Meier curve was carried out for OS of each group and the results were plotted in Figure 2. The median OS of the subgroups 1, 2, 3, and 4 were 32.4, 19.2, 17.8, and 11.6 months, respectively. Such differences suggested that patients with both normal preoperative and postoperative RBC counts could expect the best OS, whereas those patients with both decreased preoperative and postoperative RBC counts exhibit the poorest prognosis (P < 0.001). However, no statistically significant difference was found among the subgroups 2, 3, and 4.

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 (P = 0.0065), which implies a better hepatic function.In addition, low RBC count was found to be significantly associated with patients of female (P = 0.003), younger age (P =  < 0.001), and with higher AST/ALT ratio (P = 0.005).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 χ2 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 (P < 0.001). 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 (P = 0.0065), which implies a better hepatic function. In addition, low RBC count was found to be significantly associated with patients of female (P = 0.003), younger age (P =  < 0.001), and with higher AST/ALT ratio (P = 0.005). 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