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Clinical Significance of Red Cell Distribution Width and Circulating Tumor Cells with an Epithelial–Mesenchymal Transition Phenotype in Lung Adenocarcinoma

Authors Peng H, Tan X, Wang Y, Dai L, Liang G, Guo J, Chen M

Received 25 February 2020

Accepted for publication 20 May 2020

Published 26 June 2020 Volume 2020:12 Pages 5105—5117


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Eileen O'Reilly

Huajian Peng,* Xiang Tan,* Yongyong Wang, Lei Dai, Guanbiao Liang, Jianji Guo, Mingwu Chen

Department of Thoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Mingwu Chen
Department of Thoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuang Yong Road 6, Nanning 530021, Guangxi Zhuang Autonomous Region, People’s Republic of China

Objective: To determine the prognostic value of red cell distribution width (RDW) and circulating tumor cells with epithelial–mesenchymal transition phenotype (M-CTC) in lung adenocarcinoma (LUAD).
Patients and Methods: Clinical and laboratory data of 60 patients with LUAD were collected. CTCs were isolated from their peripheral blood using the CanPatrolTM CTC enrichment method. The indicators of RDW and neutrophil lymphocyte ratio (NLR) were calculated based on the laboratory standards.
Results: A total of 60 LUAD patients were enrolled, of which 19 (31.7%) had high RDW (> 0.14) and 32 (53.3%) were positive for M-CTCs. There was no significant correlation between RDW and the clinical characteristics. M-CTC was not significantly associated with tumor size and differentiation, age, gender, tumor stage, and histological type but correlated significantly with lymphatic metastasis (P = 0.044), high NLR (> 2.26, P = 0.023), and high RDW (> 0.14, P = 0.036). Furthermore, the M-CTC+ LUAD patients had a significantly poor recurrence-free survival (RFS; Log rank P =0.001, HR = 2.749, 95% CI = 1.489– 5.078) and overall survival (OS; Log rank P =0.022, HR = 2.283, 95% CI = 1.128– 4.622) compared to the M-CTC patients. Similarly, high RDW also correlated with worse RFS (Log rank P = 0.008, HR = 2.331, 95% CI = 1.248– 4.353) and OS (Log rank P = 0.004, HR = 0.004, 95% CI = 1.398– 5.525).
Conclusion: M-CTC is significantly related to RDW and NLR, and an independent prognostic factor in LUAD.

Keywords: circulating tumor cell, epithelial–mesenchymal, red cell distribution width, lung adenocarcinoma, survival

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