Can Blood Transfusions Cause Your Ca125 to Rise
Medicine (Baltimore). 2022 Apr; 96(17): e6752.
The value of ruddy cell distribution width in patients with ovarian cancer
Yuanyuan Qin
aThe First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
Peng Wang
aThe First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Democratic Region, Cathay
Zhibi Huang
bPublic Health of Guangxi Medical University.
Gaoming Huang
bPublic Health of Guangxi Medical Academy.
Jingguang Tang
aThe First Affiliated Infirmary of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, Cathay
Yi Guo
aThe First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
Ping Huang
aThe First Affiliated Hospital of Guangxi Medical Academy, Nanning, Guangxi Zhuang Autonomous Region, Communist china
Zhanfeng Lai
aThe Start Affiliated Hospital of Guangxi Medical Academy, Nanning, Guangxi Zhuang Autonomous Region, Red china
Faquan Lin
aThe First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's republic of china
Monitoring Editor: Giovanni Tarantino.
Received 2022 January 16; Revised 2022 Mar 15; Accustomed 2022 Mar 17.
Abstract
Background:
The blood-red prison cell distribution width (RDW) has attracted attending in the diagnosis of malignant tumors. In this study, we analyzed the correlation between the RDW and ovarian cancer by observing changes in the RDW in patients with ovarian cancer.
Methods:
Patients diagnosed with ovarian cancer at the First Affiliated Hospital of Guangxi Medical University, China, from 2012 to 2016, were retrospectively analyzed. Patients diagnosed with ovarian benign tumors in our hospital during the aforementioned period comprised the control group. Differences in relevant indicators were compared between the ovarian cancer and command groups using the Mann–Whitney U test. Differences in the RDW at different stages of ovarian cancer were compared using one-mode analysis of variance. Correlations betwixt the RDW and experimental parameters in patients with ovarian cancer were analyzed by Spearman correlation.
Results:
The RDW, absolute neutrophil count (N), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and cancer antigen 125 (CA-125) concentration were significantly higher in the ovarian cancer than control group. The hemoglobin concentration (Hb) and absolute lymphocyte count (L) were significantly lower in the ovarian cancer than control group. The RDW was significantly dissimilar among iv different stages of ovarian cancer. Correlation analysis demonstrated that the RDW was negatively correlated with the hemoglobin concentration (Hb). The RDW was positively correlated with the cancer stage, NLR, PLR, and CA-125 concentration. The area under the receiver-operating feature curve of the RDW was 0.876 (95% confidence interval 0.829–0.923).
Determination:
The RDW is associated with ovarian cancer and is a potential marker of its progression.
Keywords: inflammatory factor, ovarian cancer, blood-red prison cell distribution width
1. Introduction
Ovarian cancer has the highest mortality rate among cancerous tumors of the female reproductive system.[ane] The incidence of ovarian malignancies has been increasing in contempo years. In 2012, 22,280 new cases of ovarian cancer were diagnosed in the United States, and fifteen,500 of these patients died of their ovarian cancer.[two] Global statistics in 2022 showed that about 240,000 new cases were diagnosed and 150,000 deaths occurred each yr, with a mortality rate as high as 63%.[3] The ovaries are located in the pelvic cavity, and the onset of ovarian cancer is therefore occult. More than lxx% of patients with ovarian cancer lack obvious clinical manifestations and therefore practice non undergo constructive diagnostic techniques in the early stage; thus, ovarian cancer is ordinarily diagnosed at an avant-garde phase.[4] This is a leading cause of the high mortality rate associated with this cancer. Identification of low-cost biological indicators that can help to improve the early diagnosis of ovarian cancer and evaluate its prognosis thus has high clinical value.
The red prison cell distribution width (RDW) is a measure of the range of variation in the red blood cell size. The RDW reflects ruddy claret prison cell volume heterogeneity and is a function of the whole blood prison cell count. The RDW is widely used in the clinical differential diagnosis of anemia-related disease.[v] Nevertheless, increasingly more than prove is showing that a loftier RDW is strongly associated with a chance of liver illness, cardiovascular disease, and metabolic syndrome.[6–8] Use of the RDW in the diagnosis of malignant tumors has recently attracted much attention. Related enquiry has mainly focused on endometrial cancer, lung cancer, and liver cancer.[nine–eleven] To the best of our knowledge, nevertheless, the relationship between the RDW and ovarian cancer has non yet been described. In the present report, we analyzed the correlation between the RDW and ovarian cancer by observing changes in the RDW in patients with ovarian cancer.
2. Patients and methods
2.ane. Patients
A retrospective analysis of patients who were at the showtime diagnosis of ovarian cancer at the First Affiliated Hospital of Guangxi Medical University, Red china, from 2012 to 2022 was performed. Patients who met any of the following criteria were excluded: diabetes mellitus, cardiovascular disease, kidney disease, blood disease, acute inflammation, anemia, contempo fe therapy, venous thrombosis for period of >vi months, and contempo blood transfusion (inside the past 3 months). Finally, 145 patients with ovarian cancer were included. In accordance with the standards established past the International Federation of Gynecology and Obstetrics in 2000, the patients were classified into groups of unlike cancer stages.[12] 46 patients (31.7%) had phase I cancer, 34 (23.4%) had stage II, 42 (29.0%) had phase III, and 23 (xv.9%) had phase IV. 54 patients diagnosed with beneficial ovarian tumors in our hospital during the aforementioned time menstruation comprised the control grouping. These benign tumors included mature ovarian teratomas, elementary ovarian cysts, and ovarian endometriosis. This written report was canonical by the ethics committee of the First Affiliated Infirmary of Guangxi Medical University, Cathay.
2.2. Methods
Venous blood samples (2 mL) were obtained from each patient who were at the get-go diagnosis of ovarian cancer and who did non receive whatsoever treatment in the forenoon, and placed in EDTA-K2 anticoagulation tubes and drying tubes. Whole blood cell parameters were adamant with a Beckman Coulter LH 780 hematology analyzer (Beckman Coulter, Brea, CA). The RDW, hemoglobin (Hb) concentration, total number of platelets, absolute neutrophil count (N), and absolute lymphocyte count (50) were directly obtained by the hematology analyzer. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated as follows: absolute neutrophil count/absolute lymphocyte count and total number of platelets/absolute lymphocyte count, respectively. The RDW ranged from xi.0% to 14.0% in our hospital. The serum cancer antigen 125 (CA-125) concentration was detected with a Roche E6000 analyzer (Roche Diagnostics, Basel, Switzerland).
2.three. Statistical analysis
All information were analyzed using SPSS 19.0 software (IBM Corp., Armonk, NY). The Kolmogorov–Smirnov examination was used as a normality test. No measurement information met the criteria for a normal distribution (P < .01). Not-normally distributed measurement data are expressed every bit the median and quartile, and count information are expressed as frequency or rate. Differences in relevant indicators were compared between the ovarian cancer group and control group using the Mann–Whitney U test. Differences in the RDW at dissimilar stages of ovarian cancer were compared using 1-way analysis of variance. The diagnostic value of the RDW was estimated past a receiver-operating characteristic (ROC) curve. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) were besides adamant. Correlations betwixt the RDW and experimental parameters in patients with ovarian cancer were analyzed by Spearman correlation. A P value <.05 was considered statistically significant.
3. Results
In all, 145 patients with ovarian cancer (mean age 47.00 years; range 37.00–51.l years) were included in this study. According to the grading standards, 46 patients (31.7%) had stage I cancer, 34 (23.4%) had stage 2, 42 (29.0%) had stage III, and 23 (xv.nine%) had stage IV. The mean age of the 54 patients with benign ovarian tumors in the command group was 46.50 years (range 32.75–51.25 years).
The RDW, NLR, PLR, CA-125 concentration, and absolute neutrophil count were significantly higher in the ovarian cancer than control grouping (P < .05). The Hb concentration and absolute lymphocyte count were significantly lower in the ovarian cancer than command group (P < .05). The age and total number of platelets were not significantly different between the ovarian cancer and control groups (P > .05) (Table i). The RDW was significantly dissimilar among the 4 subgroups of ovarian cancer stages as follows: stage IV > stage III, phase III > stage 2, and stage II > phase I (P < .05) (Fig. 1). The ROC curve showed that the AUC of the RDW was 0.876 (95% CI 0.829–0.923, P < .001).
Table 1
Comparing of relevant parameters in the ovarian cancer and command groups.
Comparison of RDW in different stages of ovarian cancer. RDW = red cell distribution width, Stage = cancer stage.
Correlation assay demonstrated that the RDW was negatively correlated with the Hb concentration and positively correlated with the cancer phase, NLR, PLR, and CA-125 concentration (P < .05) (Fig. 2). However, the RDW was not correlated with the absolute neutrophil count or absolute lymphocyte count (both P > .05).
Correlation analysis of RDW with (A) CA-125, (B) NLR, (C) PLR, (D) Hb, and (East) cancer stage. CA-125 = cancer antigen 125, Hb = hemoglobin, NLR = neutrophil-to-lymphocyte ratio, PLR = platelet-to-lymphocyte ratio, RDW = red prison cell distribution width, Stage = cancer stage.
4. Word
The RDW reflects the heterogeneity of the cherry-red blood cell size, and an increase in the RDW suggests that the red blood cell size is non uniform. An increased RDW in peripheral blood smears may be associated with fe deficiency, vitamin B12, or folic acrid deficiency, and Hb deficiency; hemolysis or claret transfusion tin can besides cause an elevated RDW.[13] Some inflammatory factors, such as granulocyte colony-stimulating factor and erythropoietin, tin can also crusade the RDW to ascension by stimulating an increment in the volume of some red blood cells.[14]
In the present study, a high RDW was positively correlated with the stage of ovarian cancer; the higher the stage, the higher the RDW. Previous studies showed that the RDW increased in patients with malignant tumors,[9–11,fifteen–18] which is consistent with the findings of the present study. Ay et al[15] compared the RDW in patients with benign and cancerous tumors of the colon, including 115 patients with colon polyps and 30 with colon cancer. The RDW was significantly higher in patients with colon cancer than in those with colon polyps. Baicus et al[16] establish that the RDW was remarkably increased in 61 patients with cancerous tumors amid 253 patients with weight loss. Seretis et al[17] confirmed that the RDW was noticeably higher in 35 patients with breast cancer than in 14 patients with breast fibromas. A previous written report showed that the RDW was obviously associated with the number of metastatic lymph nodes, tumor diameter, and overexpression of human epidermalgrowth factor receptor-2. Recent studies take also confirmed that the RDW plays an important function in lung cancer. Koma et al[ten] verified that a high RDW was strongly associated with the cancer stage and prognosis in 332 patients with lung cancer. In the Cox proportional-hazards model of that study, an elevated RDW was an independent chance factor for lung cancer mortality. Kemal et al[9] institute that the RDW was higher in 109 patients with endometrial cancer than in 222 with benign uterine lesions, and that the RDW was associated with the cancer stage in patients with endometrial cancer. Wei et al[18] confirmed that the RDW was dramatically higher in 110 patients with chief hepatocellular carcinoma than in 68 healthy persons.
The mechanism of an elevated RDW in the blood of patients with ovarian cancer is notwithstanding under investigation. Possible mechanisms may involve the effects of inflammatory factors and/or malnutrition. Beginning, with respect to inflammatory factors, cancer is widely believed to be the upshot of chronic inflammation.[xix] Approximately 29% of cancer deaths were associated with chronic infection in 1 report.[20] The RDW is also idea to be associated with chronic inflammation.[21] Lippi et al[22] confirmed that the RDW was positively correlated with the erythrocyte sedimentation rate and high-sensitivity C-reactive protein concentration, indicating that the RDW reflects the inflammatory country of the trunk. Mantovani et al[19] believed that the inflammatory response mediated by cytokines and inflammatory mediators within the tumor may lead to the evolution, infiltration, and metastasis of cancer. Inflammatory factors tin can affect iron metabolism, inhibit erythropoietin expression, and inhibit erythrocyte maturation.[23,24] Forhecz et al[thirteen] further investigated the machinery of the RDW increment induced past inflammatory reactions and found that inflammatory factors affected iron metabolism, shortened the life of red blood cells, and resulted in the release of large numbers of immature crimson blood cells from the bone marrow into the peripheral claret circulation in accelerate; alternatively, inflammatory factors increased the rate of ineffective hematopoiesis in the bone marrow, increased the red claret cell book heterogeneity in peripheral claret, induced an increase in the RDW, suppressed the stimulating consequence of erythropoietin on bone marrow erythroid stalk cells, and prevented the antiapoptotic outcome and inhibitory effect of erythropoietin on red claret cell maturation.[13] Many cytokines, including tumor necrosis factor (TNF)-α, interleukin (IL)-ane, and IL-17, are unbalanced in patients with ovarian cancer, which is a chronic inflammatory disease. Neote et al[25] detected many types of inflammatory factor receptors on the surface of ruddy blood cells and presumed that red claret cells were involved in the inflammatory process. Hunziker et al[26] further verified that the inflammatory response and oxidative stress affected erythropoiesis and altered claret cell membrane deformability and the erythrocyte half-life bike, thereby resulting in an increased RDW. In the present report, the absolute neutrophil count, NLR, PLR, and RDW increased, and the RDW was correlated with the NLR and PLR. These findings are consistent with previous studies showing that a variety of inflammatory factors increase and that RDW serves every bit an inflammatory gene during the onset of cancer. Second, with respect to malnutrition, patients with malignant tumors often have malnutrition, gastrointestinal dysfunction, and impaired immune role. These conditions issue in deficiencies of iron, folic acid, and vitamin B12; unlike degrees of anemia; and an increased RDW.
Cancer antigen 125 (CA-125) is a clinically sensitive ovarian tumor marker. It has important diagnostic value in ovarian cancer and tin can be used to monitor handling efficacy. Moreover, the CA-125 concentration has been shown to identify the chemotherapy cycle, can be used to guess disease progression, and is an of import prognostic indicator.[27,28] In the present study, the CA-125 concentration remarkably increased in the ovarian cancer group, and the RDW was positively correlated with the CA-125 concentration. Moreover, the ROC bend showed that the AUC of the RDW was 0.876. Therefore, we conclude that the RDW is a potential marker for the progression of ovarian cancer. This report has shown that the RDW reflects the progression of ovarian cancer to a certain degree. The RDW reflects the stage of ovarian cancer (stage I, 13.78 ± i.19%; stage Ii, 14.79 ± 1.38%; stage III, 16.50 ± two.thirteen%; phase IV, 18.21 ± 1.92%) and may have value in early on diagnosis and assessment of illness progression of ovarian cancer in clinical practice. Nevertheless, the actual clinical value of the RDW is not absolute. The sample size of the present study was small, and the specific interval in which the RDW can accurately reflect the stage of ovarian cancer will require a study with a larger sample.
This written report has some limitations. This was a retrospective study of patients with ovarian cancer, and the pocket-size sample size prevents us from drawing conclusions nigh the correlation between the RDW and ovarian cancer. We did not collect relevant laboratory information regarding inflammatory factors (such as the erythrocyte sedimentation rate and concentrations of C-reactive protein, ILs, and TNF), erythropoietin, folic acid and vitamin B12 concentrations, and serum ferritin concentration. These indicators may profoundly assist to further clarify the mechanism of RDW summit in patients with ovarian cancer. Thus, a large-calibration prospective study is needed for further confirmation. Nevertheless, this is the first report on the correlation between the RDW and ovarian cancer. The data reverberate the value of the RDW in patients with ovarian cancer and provide a reference for the diagnosis of ovarian cancer progression.
5. Conclusions
In summary, the RDW was correlated with the stage of ovarian cancer, suggesting that the RDW is a potential marker for disease progression in patients with ovarian cancer. RDW detection technology is more than mature than in the past, and the various types of machines and their detection methods are basically uniform. The RDW is a laboratory indicator that is commonly used in the clinical setting, simple to mensurate, easily promoted, convenient, and cheap. Further investigation regarding its use is needed to help in the diagnosis and treatment of ovarian cancer.
Acquittance
We would similar to thank Section of Clinical Laboratory, the First Affiliated Hospital of Guangxi Medical Academy, Red china.
Footnotes
Abbreviations: CA-125 = cancer antigen 125, Hb = hemoglobin, L = accented lymphocyte count, N = absolute neutrophil count, NLR = neutrophil-to-lymphocyte ratio, PLR = platelet-to-lymphocyte ratio, RDW = red cell distribution width.
Y.Q. and P.W. contributed equally to this work and are co-first authors.
Contributed by
Authors' contributions: Y.Q. collated the study data, assisted with information analysis, and wrote the initial typhoon of the paper. P.W. conceived and designed the report. Z.H., Chiliad.H., J.T., Y.G., and P.H. collected the data and carried out statistical analysis. Z.L. and F.Fifty. revised the commodity.
Funding: This piece of work was supported by the scientific enquiry program of the Guangxi Zhuang Autonomous Region Health Department under Grant Z2009110.
The authors have no conflicts of interest to disclose.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413266/
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