Original article

NOWOTWORY Journal of Oncology

2022, volume 72, number 3, 161–166

DOI: 10.5603/NJO.2022.0026

© Polskie Towarzystwo Onkologiczne

ISSN 0029–540X, e-ISSN: 2300-2115

www.nowotwory.edu.pl

The prognostic value of RDW, NLR and PLR in sequential radio-chemotherapy for advanced lung cancer

Iwona Jabłońska1Marcin Miszczyk1Marcin Goławski2Iwona Dębosz-Suwińska3Rafał Suwiński4
1IIIrd Radiotherapy and Chemotherapy Clinic and Teaching Hospital, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
2Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
3Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
4IInd Radiotherapy and Chemotherapy Clinic and Teaching Hospital, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
Introduction. Inflammation plays an important role in carcinogenesis, therefore morphology-based inflammatory indices could be prognostic factors in lung cancer patients. This study aimed to analyze if red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are associated with patients’ prognosis in non-small cell lung cancer (NSCLC) patients.
Material and methods. The study population included 110 patients treated with definitive sequential radio-chemotherapy for stage IIIA–IIIB NSCLC. The data were retrospectively analyzed using the receiver operating characteristic (ROC) method, Kaplan-Meier estimator, log-rank testing, and Cox proportional hazards regression model.
Results. The ROC analysis has shown that the optimal cut-off values were 14% for RDW, 2.1 for NLR, and 120 for PLR, with area under the curve (AUC) of 0.606, 0.509, and 0.564 respectively. The overall survival was significantly higher in patients with RDW ≤ 14% with a median survival of 31.2 months compared to 20.2 months for patients with RDW > 14%. RDW was an independent prognostic factor in multivariate analysis.
Conclusions. RDW can provide additional information in assessing patients’ prognosis, but it is necessary to consider its modest sensitivity and specificity. NLR and PLR were not found to be independent prognostic factors.
Key words: lung cancer, red cell distribution width, RDW

How to cite:

Jabłońska I, Miszczyk M, Goławski M, Dębosz-Suwińska I, Suwiński R. The prognostic value of RDW, NLR and PLR in sequential radio-chemotherapy for advanced lung cancer. NOWOTWORY J Oncol 2022; 72: 161–166.

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

Introduction

Lung cancer is the most common cause of cancer-related death among men and the second most frequent among women with as many as 1.76 million deaths worldwide annually [1]. The disease is frequently diagnosed at an advanced stage, which is associated with a poor prognosis. Approximately 84% of lung cancers are non-small cell lung cancers (NSCLC) characterized by a 5-year overall survival rate of 24%, which is significantly higher than 6% for small cell lung cancer (SCLC) [2, 3].

Inflammation plays a significant role in cancer development and is regarded as the 7th hallmark of cancer [4]. Inflammatory cells release molecules to the tumor microenvironment, including growth factors that stimulate proliferation and survival factors that limit apoptosis. Furthermore, these molecules include proangiogenic factors and extracellular matrix-modifying enzymes, which facilitate angiogenesis, invasion, and metastasis [5].

Multiple studies indicate that blood morphology indices, such as red blood cell distribution width (RDW) [6–13], neutrophil-to-lymphocyte ratio (NLR) [14–19], and platelet-to-lymphocyte ratio (PLR) [6, 19–21], may be prognostic factors in cancer patients. Such indices could be particularly useful for clinicians given that the majority are based on routinely performed laboratory tests.

RDW indicates the variability of red blood cell volume, and it is commonly used to distinguish the etiology of anemia [22]. Higher RDW values reflect a larger variation of erythrocyte volume, which can be associated with chronic inflammation [23] and oxidative stress [24]. Likewise, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been reported as inflammation biomarkers [19, 25]. In our study, we analyzed whether parameters such as RDW, NLR, and PLR could be useful in assessing prognosis in patients treated with definitive sequential radio-chemotherapy for stage IIIA–IIIB NSCLC.

Material and methods

This retrospective analysis was based on a group of 110 patients treated for NSCLC at a single institution between January 2009 and December 2017. The following inclusion criteria were used:

thinoperable stage IIIA or IIIB NSCLC (according to the 7 edition of AJCC/UICC TNM Classification of Malignant Tumors),
radical sequential radiotherapy and chemotherapy as the primary method of treatment.

Patients with a diagnosis of a secondary malignant neoplasm, ongoing autoimmune disease, or chronic steroid uptake were excluded from the study group.

The data were collected from patients’ medical history and the Polish National Cancer Registry. Out of the initial database of 176 patients, 64 cases had to be excluded due to missing data (36.8%). The final cohort included 110 patients. The RDW was available in 81 cases (73.6%), NLR and PLR in 110 cases (100%). The indices were calculated based on laboratory tests performed before the first dose of chemotherapy (median delay of 1 day, IQR 0–10).

The vast majority of patients (97; 88.2%) received chemotherapy based on cisplatin and vinorelbine. Remaining patients received gemcitabine and carboplatin (5; 4.5%), cisplatin and etoposide (5; 4.5%), carboplatin and vinorelbine (2; 1.8%), or pemetrexed and cisplatin (1; 0.9%). The median radiotherapy dose was 67.2 Gy (IQR 66.51–69.2). The majority of the patients received radiotherapy doses ranging between 60 and 70 Gy (93.6%). The remaining patients had their total dose reduced due to treatment complications. Patients’ characteristics are presented in table I.

Table I. Patients’ characteristics

Whole group

RDW ≤14%

RDW >14%

n = 110

n = 58

n = 23

age

61.8 years

(57.1–66.4)

61.8 years

(57.1–66.4)

62.8 years

(54–66.4)

sex:

  • male
  • female

82 (74.5%)

28 (25.5%)

44 (75.9%)

14 (24.1%)

16 (69.6%)

7 (30.4%)

history of smoking:

  • non-smoker
  • active or former smoker
  • pack-years

13 (11.8%)

95 (86.4%)

33.0 (20–42)

10 (17.2%)

48 (82.8%)

30 (0–64.5)

1 (4.3%)

20 (86.9%)

32.5 (0–58.5)

blood panel:

  • WBC
  • RBC
  • HGB
  • RDW
  • NLR
  • PLR

8.6 (7.1–10.1)

4.6 (4.3–4.9)

13.6 (12.6–14.5)

13.4 (12.9–14.1)

2.8 (2.1–3.9)

145.1 (107.8–232.9)

8.2 (6.8–9.7)

4.7 (4.4–4.9)

13.9 (13.4–14.7)

13.1 (12.7–13.6)

2.5 (2.0–3.4)

147.4 (107.3–200.6)

8.8 (7.3–10.5)

4.5 (3.9–4.9)

12.3 (11.2–13.7)

15.0 (14.3–16.9)

2.6 (1.9–3.6)

132.9 (107.8–232.9)

stage:

  • IIIA
  • IIIB

73 (66.4%)

37 (33.6%)

40 (69%)

18 (31%)

10 (43.5%)

13 (56.5%)

type:

  • adenocarcinoma
  • squamous cell carcinoma
  • large cell
  • NOS (not otherwise specified)

17 (15.5%)

69 (62.7%)

5 (4.5%)

19 (17.3%)

11 (19.0%)

37 (63.8%)

2 (3.4%)

8 (13.8%)

5 (21.7%)

12 (52.2%)

2 (8.7%)

4 (17.4%)

Zubrod score:

  • 0
  • 1
  • 2

35 (31.8%)

73 (66.4%)

2 (1.8%)

23 (39.7%)

34 (58.6%)

1 (1.7%)

6 (26.09%)

16 (69.56%)

1 (4.35%)

GTV (cc):

  • primary
  • nodal

34.2 (16.0–56.3)

2.85 (0.0–8.9)

27.8 (4.3–203.2)

2.65 (0.0–37.1)

43.2 (6.4–471.0)

5.8 (0.0–15.9)

The receiver operating characteristic (ROC), Kaplan-Meier estimator, log-rank testing, and Cox proportional hazards regression model were used for the analysis. Median OS was chosen as a cut-off point for the ROC analysis. The univariate Cox analysis was performed using known clinical factors. Statistically significant cofactors (p-value < 0.05) were included in the multivariable analysis (MVA, tab. II). Due to the inclusion of corresponding variables, the MVA was performed twice, using RDW, NLR, and PLR as continuous and binary indices. The Spearman Rank Correlation test was used to assess the correlation between the RDW or primary gross tumor value (GTVp) and hemoglobin concentration (HGB). The statistical analysis was performed using the STATISTICA 13.3 by TIBCO Software Inc.

Results

The median overall survival (OS) was 27 months; 17 (15.5%) patients were alive at the time of the analysis.

The ROC analysis (fig. 1) showed that RDW had the highest discriminatory value for overall survival (AUC = 0.606; 95% CI: 0.479–0.733). PLR (AUC = 0.564; 95% CI: 0.452–0.675) and NLR (AUC = 0.509; 95% CI: 0.398–0.619) had lower discriminatory values.

Figure 1. ROC analysis based on RDW, PLR, and NLR for OS in patients treated with sequential radio-chemotherapy for advanced inoperable NSCLC

In the univariate Cox regression model, RDW as a continuous value and histopathological diagnosis of squamous cell carcinoma were associated with increased mortality risk as well as RDW, NLR, and PLR presented as binary values categorized by Youden index value (tab. II). In the MVA, squamous cell carcinoma (SCC) histopathology became nearly statistically significant (p = 0.051), while GTVp and RDW remained independent prognostic factors. When presenting blood indices as binary variables, RDW, SCC histopathology, and primary GTV remained independent prognostic factors, while NLR and PLR were non-significant (tab. II).

Table II. Univariate and multivariate COX regression analysis

Univariate analysis

HR (95% CI)

p-value

sex (male)

1.080 (0.654–1.784)

0.765

smoking

0.816 (0.815–3.509)

0.158

pack-years

0.999 (0.989–1.009)

0.802

RDW

1.227 (1.054–1.430)

0.008

RDW (>14%)

2.434 (1.420–4.173)

0.001

NLR (>2.1)

0.547 (0.336–0.889)

0.015

PLR (>120)

0.592 (0.377–0.928)

0.022

hemoglobin

0.937 (0.807–1.088)

0.395

neutrophil count

1.029 (0.956–1.107)

0.446

platelet count

1 (0.999–1.001)

0.926

lymphocyte count

1.28 (0.916–1.799)

0.154

TNM stage (IIIB vs. IIB–IIIA)

1.216 (0.774–1.912)

0.396

type – squamous cell carcinoma

1.619 (1.038–2.524)

0.034

type – adenocarcinoma

0.535 (0.258–1.110)

0.093

type – NOS

0.727 (0.438–1.109)

0.217

Zubrod (1–2 vs. 0)

1.496 (0.927–2.415)

0.099

primary GTV (per cc)

1.004 (1.002–1.007)

0.0006

nodal GTV (per cc)

1.000 (0.986–1.014)

0.997

total GTV (per cc)

1.003 (1.001–1.006)

0.002

Multivariate analysis

RDW, NLR and PLR as continuous variables

RDW

1.179 (1–1.39)

0.049

type – squamous cell carcinoma

1.558 (0.997–2.43)

0.051

primary GTV (per cc)

1.003 (1.000–1.006)

0.009

RDW, NLR and PLR as binary variables separated by Youden index value

RDW (>14%)

2.048 (1.155–3.632)

0.014

NLR (>2.1)

0.584 (0.33–1.033)

0.065

PLR (>120)

0.648 (0.378–1.111)

0.115

type – squamous cell carcinoma

1.717 (1.093–2.695)

0.019

primary GTV (per cc)

1.004 (1.002–1.007)

<0.001

The overall survival was significantly higher in patients with RDW ≤ 14%, with a median survival of 31.2 months compared to 20.2 months for patients with RDW > 14% (fig. 2, p = 0.006).

Figure 2. Overall survival stratified by RDW in patients treated with sequential radio-chemotherapy for advanced inoperable NSCLC

Discussion

Inflammation plays an important role in tumor development, including angiogenesis, tumor invasion, and metastasis. Many molecules released by the inflammatory cells to the tumor environment promote cancer development [5, 26]. Elevated expression of various inflammatory biomarkers, including interleukin-10 (IL-10) and transforming growth factor (TGF-β), were found to be associated with poor survival in patients with NSCLC [27, 29].

The correlation between C-reactive protein, erythrocyte sedimentation rate (ESR), and RDW was reported by Lippi et al. in 2009 [23]. In another study, by Allen et al. reported a correlation of RDW and different inflammatory biomarkers; it was suggested that RDW may reflect pathologic processes, such as inflammatory stress and impaired iron metabolism [30]. Since RDW can be considered a marker of chronic inflammation, its elevated value may be associated with poor survival in patients.

In this study, overall survival (OS) was significantly lower in patients with higher RDW as well as higher PLR and NLR, when the latter two were expressed as binary values. Furthermore, as shown in table I, patients with RDW > 14% had lower HGB and RBC than those with RDW ≤ 14%, higher median GTVp, and more frequently stage IIIB disease. Additionally, there was a statistically significant correlation between HGB and RDW (p = 0.002). However, the HGB was not significantly associated with survival (tab. II), while RDW was found to be an independent prognostic factor.

Many authors reported that elevated RDW values are associated with an advanced cancer stage in NSCLC [7, 31, 32]. In our study, we have shown that RDW can also provide additional prognostic insights in patients presenting advanced disease (IIIA–IIIB). Chen et al. found that among 245 NSCLC patients, RDW ≥ 13.25 was significantly correlated with cancer stage III–IV [31]. In a study conducted by Song et al. RDW > 12.95 was strongly associated with the IIIB and IV stage of NSCLC [32]. Koma et al. conducted a study to assess the association between RDW levels and prognosis in 332 patients with NSCLC (stages I–IV) [7]. In the last study, the authors divided patients into two groups: the early (stage I–II) and advanced cancer stage (stage III–IV). In the early stage group, higher RDW levels (>15%) were associated with prognosis, but such association was not found in the advanced stage group [7]. The RDW was also found as potentially helpful in screening, as RDW varies significantly between healthy adults and NSCLC patients [31, 32].

In this analysis, in contrast to other studies, we analyzed RDW both as a continuous and binary variable. The conversion of continuous variables into binary variables can lead to overfitting and lack of reproducibility of results, especially considering the relatively low AUC values for each investigated index (0.606, 0.564, and 0.509 respectively). While setting a cut-off value can produce statistically significant results, those values vary in different studies. Koma et al. established a cut-off value of 15% [7]. Toyokawa et al. used 14.5% as a cut-off value, which they described as “the upper limit of the hospital laboratory normal range” [33]. Ichinose et al. used a cut-off value of 13.8 [34]. Some authors used quartiles or tertiles to divide patients into groups, such as Kiriu et al. [35] or Warwick et al. [36]. In our study, we have shown that RDW remains a significant prognostic factor even as a continuous variable, and although defining a single cut-off value remains controversial, higher RDW values are universally associated with poorer prognosis in NSCLC patients.

The strength of our study lies in the analysis of RDW influence on prognosis in patients limited to stage III NSCLC, decreasing the influence of cancer stage on prognosis, and the use of RDW as both a continuous and binary index in COX regression analysis, which is less prone to overfitting. We acknowledge the study limitations, including the small group size, retrospective design, and limited clinical data available. Additionally, concurrent radio-chemotherapy and immunotherapy with durvalumab are currently considered to be the standard of care for advanced NSCLC patients, superseding sequential radio-chemotherapy. However, due to the recent introduction of durvalumab to clinical practice [37–39], there is limited follow-up data available. Moreover, sequential radio-chemotherapy remains in use for patients with contraindications for concurrent therapy [39, 40].

Conclusions

The introduction of RDW to the initial patient assessment might improve the prognostic accuracy, as RDW was determined to be an independent prognostic factor for the OS in non-operative stage IIIA and IIIB NSCLC, albeit with limited specificity and sensitivity. Both NLR and PLR were not found to be statistically significant prognostic factors in our analysis.

Conflict of interest: none declared

Marcin Goławski

Medical University of Silesia

Department of Biophysics, Faculty of Medical Sciences in Zabrze

ul. Jordana 19

41-808 Zabrze, Poland

e-mail: martin.golawski@gmail.com

Received: 19 Nov 2021
Accepted: 2 Feb 2022

References

  1. Cancer [Internet]. Geneva: World Health Organisation; 3 Mar 2021. https://www.who.int/news-room/fact-sheets/detail/cancer (19.03.2021).
  2. Cancer A–Z [Internet]. Atlanta: American Cancer Society; c2021. Lung cancer: key statistics for lung cancer; c2021. https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html (20.03.2021).
  3. Cancer A–Z [Internet]. Atlanta: American Cancer Society; c2021. Lung cancer: early detection, diagnosis and staging: lung cancer survival rates; c2021. https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/survival-rates.html?fbclid=IwAR1XssnYQXP7B_51krxuQPwi_3BCS8x3bmBCZWJ0fiXCjNUQ9QeDUyGjHNY (20.03.2021).
  4. Colotta F, Allavena P, Sica A, et al. Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability. Carcinogenesis. 2009; 30(7): 1073–1081, doi: 10.1093/carcin/bgp127, indexed in Pubmed: 19468060.
  5. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011; 144(5): 646–674, doi: 10.1016/j.cell.2011.02.013, indexed in Pubmed: 21376230.
  6. Łochowski M, Chałubińska-Fendler J, et al. Łochowska Prognostic value of red blood cell distribution width-standard deviation (RDW-SD) in patients operated on due to non-small cell lung cancer. J Thorac Dis. 2020; 12: 773–781, doi: 10.21037/jtd.2019.12.94.
  7. Koma Y, Onishi A, Matsuoka H, et al. Increased red blood cell distribution width associates with cancer stage and prognosis in patients with lung cancer. PLoS One. 2013; 8: e80240, doi: 10.1371/journal.pone.0080240.
  8. Miszczyk M, Jabłońska I, Magrowski Ł, et al. The association between RDW and survival of patients with squamous cell carcinoma of the tongue. Simple, cheap and convenient? Rep Pract Oncol Radiother. 2020; 25(4): 494–499, doi: 10.1016/j.rpor.2020.03.026, indexed in Pubmed: 32477015.
  9. Li J, Yang X, Ma J, et al. Relationship of red blood cell distribution width with cancer mortality in hospital. Biomed Res Int. 2018: 8914617, doi: 10.1155/2018/8914617.
  10. Riedl J, Posch F, Königsbrügge O, et al. Red cell distribution width and other red blood cell parameters in patients with cancer: association with risk of venous thromboembolism and mortality. PLoS ONE. 2014; 9: e111440, doi: 10.1371/journal.pone.0111440.
  11. Wang Y, Zhou Y, Zhou K, et al. Prognostic value of pre-treatment red blood cell distribution width in lung cancer: a meta-analysis. Biomarkers. 2020; 25: 241–247, doi: 10.1080/1354750X.2020.1731763.
  12. Wang PF, Song SY, Guo H, et al. Prognostic role of pretreatment red blood cell distribution width in patients with cancer: A meta-analysis of 49 studies. J Cancer. 2019; 10: 4305–4317, doi: 10.7150/jca.31598.
  13. Hirahara N, Tajima Y, Fuji Y, et al. Comprehensive analysis of red blood cell distribution width as a preoperative prognostic predictor in gastric cancer. Anticancer Res. 2019; 39: 3121–3130, doi: 10.21873/anticanres.13448.
  14. Walsh SR, Cook EJ, Goulder F, et al. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005; 91(3): 181–184, doi: 10.1002/jso.20329, indexed in Pubmed: 16118772.
  15. Pryt M, Kalwas M, Nejc D, et al. Can we predict lymph node metastasis by using preoperative markers in gastric cancer patients? Nowotwory J Oncolology. 2019; 69(1): 7–11, doi: 10.5603/njo.2019.0002.
  16. Gomez D, Farid S, Malik HZ, et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma. World J Surg. 2008; 32(8): 1757–1762, doi: 10.1007/s00268-008-9552-6, indexed in Pubmed: 18340479.
  17. Halazun KJ, Aldoori A, Malik HZ, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol. 2008; 34(1): 55–60, doi: 10.1016/j.ejso.2007.02.014, indexed in Pubmed: 17448623.
  18. Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014; 106(6): dju124, doi: 10.1093/jnci/dju124, indexed in Pubmed: 24875653.
  19. Proctor MJ, Morrison DS, Talwar D, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer. 2011; 47(17): 2633–2641, doi: 10.1016/j.ejca.2011.03.028, indexed in Pubmed: 21724383.
  20. Smith RA, Bosonnet L, Raraty M, et al. Preoperative platelet-lymphocyte ratio is an independent significant prognostic marker in resected pancreatic ductal adenocarcinoma. Am J Surg. 2009; 197(4): 466–472, doi: 10.1016/j.amjsurg.2007.12.057, indexed in Pubmed: 18639229.
  21. Templeton AJ, Ace O, McNamara MG, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2014; 23(7): 1204–1212, doi: 10.1158/1055-9965.EPI-14-0146, indexed in Pubmed: 24793958.
  22. Sultana GS, Haque SA, Sultana T, et al. Value of red cell distribution width (RDW) and RBC indices in the detection of iron deficiency anemia. Mymensingh Med J. 2013; 22: 370–376.
  23. Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med. 2009; 133: 628–32, doi: 10.5858/133.4.628.
  24. Bujak K, Wasilewski J, Osadnik T, et al. The prognostic role of red blood cell distribution width in coronary artery disease: a review of the pathophysiology. Dis Markers. 2015; 2015: 1–12, doi: 10.1155/2015/824624.
  25. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001; 102(1): 5–14, indexed in Pubmed: 11723675.
  26. Gomes M, Teixeira AL, Coelho A, et al. The role of inflammation in lung cancer. Adv Exp Med Biol. 2014; 816: 1–23, doi: 10.1007/978-3-0348-0837-8_1, indexed in Pubmed: 24818717.
  27. Li J, Shen C, Wang X, et al. Prognostic value of TGF-β in lung cancer: systematic review and meta-analysis. BMC Cancer. 2019; 19(1): 691, doi: 10.1186/s12885-019-5917-5, indexed in Pubmed: 31307405.
  28. Zeni E, Mazzetti L, Miotto D, et al. Macrophage expression of interleukin-10 is a prognostic factor in nonsmall cell lung cancer. Eur Respir J. 2007; 30(4): 627–632, doi: 10.1183/09031936.00129306, indexed in Pubmed: 17537769.
  29. De Vita F, Orditura M, Galizia G, et al. Serum interleukin-10 levels as a prognostic factor in advanced non-small cell lung cancer patients. Chest. 2000; 117(2): 365–373, doi: 10.1378/chest.117.2.365, indexed in Pubmed: 10669676.
  30. Allen LA, Felker GM, Mehra MR, et al. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail. 2010; 16: 230–238, doi: 10.1016/j.cardfail.2009.11.003.
  31. Chen J, Wu J, Lv X, et al. The value of red blood cell distribution width, neutrophil-to-lymphocyte ratio, and hemoglobin-to-red blood cell distribution width ratio in the progression of non-small cell lung cancer. PLoS One. 2020; 15: e0237947, doi: 10.1371/journal.pone.0237947.
  32. Song B, Shi P, Xiao J, et al. Utility of red cell distribution width as a diagnostic and prognostic marker in non-small cell lung cancer. Sci Rep. 2020; 10: 15717, doi: 10.1038/s41598-020-72585-4.
  33. Toyokawa G, Shoji F, Yamazaki K, et al. Significance of the red blood cell distribution width in resected pathologic stage I nonsmall cell lung cancer. Semin Thorac Cardiovasc Surg. 2020; 32: 1036–1045, doi: 10.1053/j.semtcvs.2019.04.011.
  34. Ichinose J, Murakawa T, Kawashima M, et al. Prognostic significance of red cell distribution width in elderly patients undergoing resection for non-small cell lung cancer. J Thorac Dis. 2016; 8: 3658–3666, doi: 10.21037/jtd.2016.12.44.
  35. Kiriu T, Yamamoto M, Nagano T, et al. Prognostic value of red blood cell distribution width in non-small cell lung cancer treated with anti-Programmed Cell Death-1 antibody. In Vivo (Highlands). 2019; 33: 213–220, doi: 10.21873/invivo.11462.
  36. Warwick R, Mediratta N, Shackcloth M, et al. Preoperative red cell distribution width in patients undergoing pulmonary resections for non-small-cell lung cancer. Eur J Cardiothorac Surg. 2013; 45: 108–113, doi: 10.1093/ejcts/ezt275.
  37. Łaczmańska I, Dębicka I, Gil J, et al. Medycyna personalizowana w raku płuca. Nowotwory J Oncolology. 2021; 71(2): 122–128, doi: 10.5603/njo.2021.0026.
  38. Imfinzi [Internet]. Amsterdam: European Medicines Agency. https://www.ema.europa.eu/en/medicines/human/EPAR/imfinzi (21.01.2022).
  39. Krzakowski M, Jassem J, Antczak A, et al. Cancer of the lung, pleura and mediastinum. Oncol Clin Pract. 2019; 15(1), doi: 10.5603/OCP.2018.0056.
  40. NCCN Guidelines Version 1.2022 Non-Small Cell Lung Cancer [Internet]. Plymouth Meeting: National Comprehensive Cancer Network; 7 Dec 2021. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1450 (19.03.2021).

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Wydawcą serwisu jest VM Media sp. z o.o. VM Group sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl