Elevated Platelet Distribution Width Predicts Poor Prognosis in Gallbladder Carcinoma

Figures & data

Table 1 Baseline Characteristics of Patients with GBC According to PDW Levels

Variables	Total (n=303)	PDW$\le$14.95 (n=141)	PDW>14.95 (n=162)	P -value
Age, years (range)	62 (33–85)	62 (33–85)	63 (38–85)	0.870
Gender (%)				0.064
Female	203 (67.0)	102 (72.3)	101 (62.3)
Male	100 (33.0)	39 (27.7)	61 (37.7)
Cholelithiasis (%)				0.200
Absent	157 (51.8)	67 (47.5)	90 (55.6)
Present	146 (48.2)	74 (52.5)	72 (44.4)
TB, umol/L (range)	12.4 (4.0–287.3)	12.7 (4.7–287.3)	11.8 (4.0–279.1)	0.197
ALT, IU/L (range)	23 (6–842)	23 (6–842)	23 (9–842)	0.847
AST, IU/L (range)	24 (13–850)	25 (13–850)	24 (13–850)	0.922
ALB, g/L (range)	41.0 (26.4–52.4)	41.0 (30.2–51.4)	40.9 (26.4–52.4)	0.351
WBC, $\times$10^9/L (range)	6.13 (2.42–16.43)	5.92 (2.42–15.01)	6.29 (2.95–16.43)	0.021
PLT,$\times$$\times$10^9/L (range)	205 (23–480)	210 (74–480)	199 (23–476)	0.027
NLR (range)	2.74 (0.87–13.95)	2.85 (0.92–12.50)	2.59 (0.87–13.95)	0.797
PLR (range)	136.84 (13.86–798.08)	153.53 (44.62–798.08)	125.86 (13.86–476.54)	0.008
PNI (range)	46.8 (30.2–64.2)	47.4 (30.2–64.2)	46.2 (31.0–61.4)	0.881
CA19-9, U/mL (range)	23.23 (0.1->1000)	22.48 (0.1->1000)	24.47 (0.1->1000)	0.071
CEA, U/mL (range)	2.81 (0.27->1000)	2.74 (0.27->1000)	2.90 (0.28->1000)	0.524
Pre-operative biliary drainage (%)				0.327
Absent	273 (90.1)	124 (87.9)	149 (92.0)
Present	30 (9.9)	17 (12.1)	13 (8.0)
Surgical procedures (%)				0.781
Simple cholecystectomy	25 (8.3)	13 (9.2)	12 (7.4)
Extent of hepatectomy
Wedge resection	46 (15.2)	24 (17.0)	22 (13.6)
Segment IVb and V resection	163 (53.8)	75 (53.2)	88 (54.3)
Right trisegmentectomy	19 (6.3)	7 (5.0)	12 (7.4)
Right hemihepatectomy	50 (16.5)	22 (15.6)	28 (17.3)
Pancreatoduodenectomy (%)				0.457
Absent	287 (94.7)	135 (95.7)	152 (93.8)
Present	16 (5.3)	6 (4.3)	10 (6.2)
Hepatic artery reconstruction (%)				0.689
Absent	284 (93.7)	133 (94.3)	151 (93.2)
Present	19 (6.3)	8 (5.7)	11 (6.8)
Portal-vein reconstruction (%)				0.855
Absent	285 (94.1)	133 (94.3)	152 (93.8)
Present	18 (5.9)	8 (5.7)	10 (6.2)
Adjacent organs resection (Colon/Stomach/duodenum) (%)				0.582
Absent	284 (93.7)	131 (92.9)	153 (94.4)
Present	19 (6.3)	10 (7.1)	9 (5.6)
Incidental gallbladder carcinoma (%)				0.218
Yes	76 (25.1)	40 (28.4)	36 (22.2)
No	227 (74.9)	101 (71.6)	126 (77.8)
Lymphadenectomy (%)				0.567
Absent	25 (8.3)	13 (9.2)	12 (7.4)
Present	278 (91.7)	128 (90.8)	150 (92.6)
No. of retrieved Lymph nodes [range]	5 (1–18)	5 (1–18)	5 (1–18)	0.796
No. of positive Lymph nodes [range]	3 (1–14)	2 (1–13)	3 (1–14)	0.673
Vascular invasion (%)				0.531
Absent	248 (81.8)	118 (83.7)	130 (80.2)
Present	55 (18.2)	23 (16.3)	32 (19.8)
Perineural invasion (%)				0.250
Absent	244 (80.5)	118 (83.7)	126 (77.8)
Present	59 (19.5)	23 (16.3)	36 (22.2)
Tumor differentiation (%)				0.138
Well/moderate	157 (51.8)	80 (56.7)	77 (47.5)
Poor	146 (48.2)	61 (43.3)	85 (52.5)
T stage (%)				0.052
T1	18 (5.9)	9 (6.4)	9 (5.6)
T2	120 (39.6)	67 (47.5)	53 (32.7)
T3	125 (41.3)	50 (35.5)	75 (46.3)
T4	40 (13.2)	15 (10.6)	25 (15.4)
N stage (%)				0.049
N0	145 (47.9)	76 (53.9)	69 (42.6)
N1/2	158 (52.1)	65 (46.1)	93 (57.4)
Margin status (%)				1.000
R0	243 (80.2)	113 (80.1)	130 (80.2)
R1	60 (19.8)	28 (19.9)	32 (19.8)
AJCC stage (%)				0.019
I/II	109 (36.0)	61 (43.3)	48 (29.6)
III/IV	194 (64.0)	80 (56.7)	114 (70.4)
Postoperative adjuvant therapy (%)				0.907
Yes	74 (24.4)	34 (24.1)	40 (24.7)
No	229 (75.6)	107 (75.9)	122 (75.3)

Abbreviations: GBC, gallbladder carcinoma; PDW, platelet distribution width; TB, total bilirubin; ALT, alanine aminotransferase; AST, aspartate transaminase; ALB, albumin; WBC, white blood cell count; PLT, platelet; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; PNI, prognostic nutritional index; CA 19–9, carbohydrate antigen 19–9; CEA, carcinoembryonic antigen; T, tumor depth; N, lymph node; AJCC, American Joint Committee on Cancer.

Figure 1 Optimal cut-off value for the PDW was identified by ROC curve analysis.

Figure 2 Kaplan–Meier overall survival curves of patients with GBC. (A) Overall survival of 303 patients with GBC. (B) comparing survival outcomes between the PDW≤14.95 group and PDW>14.95 group.

Table 2 Univariate and Multivariate Analysis of Overall Survival in Patients with GBC

	Univariate Analysis			Multivariate Analysis
Variables	HR	95% CI	P	HR	95% CI	P
Age, years (>62 versus$\le$62)	0.871	0.664–1.141	0.316
Gender (female versus male)	0.911	0.686–1.209	0.518
Cholelithiasis (absent versus present)	1.213	0.925–1.590	0.163
TB, umol/L (>12.4 versus $\le$12.4)	1.037	0.792–1.359	0.790
ALT, IU/L (>23 versus $\le$23)	1.066	0.813–1.397	0.645
AST, IU/L (>24 versus $\le$24)	1.242	0.948–1.628	0.115
ALB, g/L (>41.0 versus $\le$41.0)	0.775	0.589–1.018	0.067
WBC, $\times$10^9/L (>6.13 versus $\le 6$.13)	1.233	0.940–1.617	0.130
PLT,$\times$10^9/L (>205 versus $\le$205)	1.106	0.845–1.448	0.463
PDW (>14.95 versus $\le$14.95)	1.796	1.357–2.376	<0.001	1.976	1.474–2.650	<0.001
NLR (>2.74 versus $\le$2.74)	1.576	1.199–2.070	0.001	1.157	0.869–1.542	0.317
PLR (>136.84 versus $\le$136.84)	2.229	1.680–2.957	<0.001	1.894	1.406–2.550	<0.001
PNI (>46.8 versus $\le$46.8)	0.922	0.701–1.212	0.559
CA19-9, U/mL (>23.23 versus $\le$23.23)	1.736	1.318–2.285	<0.001	1.283	0.949–1.735	0.106
CEA, U/mL (>2.81 versus $\le$2.81)	1.286	0.982–1.684	0.068
Pre-operative biliary drainage (absent versus present)	1.315	0.864–2.000	0.201
IGBC (absent versus present)	0.302	0.211–0.431	<0.001	0.370	0.250–0.547	<0.001
Vascular invasion (absent versus present)	1.704	1.220–2.381	0.002	1.302	0.914–1.854	0.144
Perineural invasion (absent versus present)	1.515	1.092–2.102	0.013	1.132	0.804–1.595	0.478
Tumor differentiation (well/moderate versus poor)	1.626	1.235–2.141	0.001	1.344	1.010–1.790	0.043
T stage (T1/2 versus T3/4)	3.576	2.602–4.915	<0.001	1.496	1.024–2.185	0.037
N stage (N0 versus N1/2)	3.400	2.502–4.620	<0.001	2.034	1.440–2.873	<0.001
Margin status (R0 versus R1)	2.497	1.786–3.492	<0.001	1.753	1.241–2.477	0.001
Postoperative adjuvant therapy (yes versus no)	1.194	0.877–1.626	0.259

Abbreviations: GBC, gallbladder carcinoma; HR, hazard ratio; CI, confidence interval; TB, total bilirubin; ALT, alanine aminotransferase; AST, aspartate transaminase; ALB, albumin; WBC, white blood cell count; PLT, platelet; PDW, platelet distribution width; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; PNI, prognostic nutritional index; CA 19–9, carbohydrate antigen 19–9; CEA, carcinoembryonic antigen; AJCC, American Joint Committee on Cancer.