High Red Cell Distribution Width Independently Predicts Adverse Survival in Patients with Newly Diagnosed Skull Base Chordoma

Figures & data

Table 1 Association Between MCV, RDW and Clinicopathological Features of Skull Base Chordoma Patients

Variables	Total, N	MCV (fl), N			RDW (%), N
		<84.2 (N = 20)	≥84.2 (N = 167)	P value	<12.7 (N = 93)	≥12.7 (N = 94)	P value
Age, year				0.155			0.019*
Mean ± SD	40.1 ± 15.3	35.6 ±15.5	40.7 ± 15.2		37.5 ± 14.7	42.7 ± 15.4
Sex				0.820			0.123
Male	98	10	88		54	44
Female	89	10	79		39	50
Tumor volume, cm^3				0.748			0.566
Mean ± SD	31.7 ± 33.2	36.9 ± 56.9	31.1 ± 29.4		30.9 ± 30.4	32.5 ± 35.9
Texture				0.136			0.035*
Soft	57	9	48		35	22
Tough/moderate	130	11	119		58	72
Blood supply				0.520			0.408
Abundant	109	13	96		57	52
Poor/ moderate	78	7	71		36	42
Pathology type				0.022*			0.253
Classical	126	18	108		59	67
Chondroid	61	2	59		34	27
Al-Mefty classification				0.291			0.695
Type I	34	6	28		19	15
Type II	89	7	85		44	45
Type III	64	7	57		30	34
Brainstem involvement				0.076			0.191
No	69	11	58		30	39
Yes	118	9	109		63	55
Posterior cranial nerve involvement				0.243			0.836
No	118	15	103		58	60
Yes	69	5	64		35	34
Hb (g/L)				0.018*			0.003*
Mean ± SD	143.1 ± 16.0	130.5 ± 24.1	144.6 ± 14.1		146.6 ± 14.2	139.7 ± 16.9
MCV(fl)				—			0.475
Mean ± SD	88.9 ± 4.9	—	—		89.0 ± 3.5	88.8 ± 6.0
RDW (%)				0.001*			—
Mean ± SD	12.9 ± 1.0	14.1 ± 2.1	12.7 ± 0.7		—	—

Note: *Indicate p < 0.05.

Abbreviations: SD, standard deviation; Hb, hemoglobin; MCV, mean corpuscular volume; RDW, red cell distribution width.

Figure 1 Levels of MCV and RDW were correlated with the prognosis of chordoma patients. (A and B) Distribution of MCV, RDW, recurrent status, survival status in 187 skull base chordoma patients. (C) Patients with lower MCV had shorter PFS and OS. (D) Patients with higher RDW had shorter PFS and OS.

Abbreviations: MCV, mean corpuscular volume; RDW, red cell distribution width; PFS, progression-free survival; OS, overall survival.

Figure 2 Kaplan–Meier curves of MCV or RDW in different pathological types of skull base chordoma patients. (A) PFS analysis of MCV in classical chordoma patients. (B) PFS analysis of MCV in chondroid chordoma patients. (C) OS analysis of MCV in classical chordoma patients. (D) OS analysis of MCV in chondroid chordoma patients. (E) PFS analysis of RDW in classical chordoma patients. (F) PFS analysis of RDW in chondroid chordoma patients. (G) OS analysis of RDW in classical chordoma patients. (H) OS analysis of RDW in chondroid chordoma patients.

Abbreviations: MCV, mean corpuscular volume; RDW, red cell distribution width; PFS, progression-free survival; OS, overall survival.

Table 2 Univariate and Multivariate Cox Analysis for PFS in Skull Base Chordoma

Variables	Univariate Analysis			Multivariate Analysis
	HR	95% CI	P value	HR	95% CI	P value
Age (>55 versus ≤55years)	1.564	1.022–2.394	0.040*	1.837	1.146–2.943	0.011*
Gender (female versus male)	1.075	0.760–1.518	0.684
Tumor volume (>20 versus ≤20cm^3)	1.701	1.195–2.423	0.003*	NA	NA	0.786
Tumor texture (tough/moderate versus soft)	1.686	1.129–2.520	0.011*	NA	NA	0.071
Blood supply (abundant versus poor/moderate)	1.490	1.038–2.140	0.031*	1.543	1.038–2.294	0.032*
Pathology (classical versus chondroid)	1.601	1.087–2.358	0.017*	NA	NA	0.086
Al-Mefty classification (type III versus type I and II)	1.903	1.336–2.710	<0.001*	1.547	1.055–2.268	0.026*
Brainstem involvement (yes versus no)	1.220	0.850–1.750	0.281
Posterior cranial nerve involvement (yes versus no)	1.161	0.814–1.656	0.410
Extent of resection (non-total versus total resection)	2.794	1.690–4.618	<0.001*	2.623	1.536–4.479	<0.001*
Postoperative radiotherapy (yes versus no)	1.441	0.998–2.079	0.051	NA	NA	0.084
Hb (<120 versus ≥120 g/L)	1.229	0.624–2.422	0.551
MCV (<84.2 versus ≥84.2 fl)	1.670	1.000–2.787	0.050	NA	NA	0.103
RDW (≥12.7 versus <12.7%)	1.605	1.131–2.277	0.008	1.852	1.268–2.703	0.001*

Note: *Indicate p <0.05.

Abbreviations: PFS, progression free survival; HR, hazard ratio; CI, confidence interval; NA, not acquired; Hb, hemoglobin; MCV, mean corpuscular volume; RDW, red cell distribution width.

Table 3 Univariate and Multivariate Cox Analysis for OS in Skull Base Chordoma

Variables	Univariate Analysis			Multivariate Analysis
	HR	95% CI	P value	HR	95% CI	P value
Age (>55 versus ≤55years)	1.852	1.072–3.198	0.027*	1.945	1.117–3.387	0.019*
Gender (female versus male)	0.975	0.613–1.551	0.916
Tumor volume (>20 versus ≤20cm^3)	1.697	1.056–2.728	0.029*	NA	NA	0.466
Tumor texture (tough/moderate versus soft)	1.612	0.935–2.780	0.086	NA	NA	0.468
Blood supply (abundant versus poor/moderate)	1.912	1.149–3.182	0.013*	1.920	1.147–3.214	0.013*
Pathology (classical versus chondroid)	2.027	1.162–3.536	0.013*	1.825	1.044–3.185	0.035*
Al-Mefty classification (type III versus type I and II)	1.876	1.178–2.988	0.008*	NA	NA	0.064
Brainstem involvement (yes versus no)	1.013	0.630–1.629	0.956
Posterior cranial nerve involvement (yes versus no)	1.287	0.802–2.064	0.295
Extent of resection (non-total versus total resection)	3.390	1.552–7.405	0.002*	3.807	1.728–8.387	0.001*
Postoperative radiotherapy (yes versus no)	0.794	0.479–1.317	0.371
Hb (<120 versus ≥120 g/L)	1.118	0.450–2.776	0.810
MCV (<84.2 versus ≥84.2 fl)	1.980	1.085–3.613	0.026*	NA	NA	0.405
RDW (≥12.7 versus <12.7%)	2.404	1.473–3.924	<0.001*	2.757	1.675–4.539	<0.001*

Note: *Indicate p < 0.05.

Abbreviations: OS, overall survival; HR, hazard ratio; CI, confidence interval; NA, not acquired; Hb, hemoglobin; MCV, mean corpuscular volume; RDW, red cell distribution width.

Figure 3 Development of nomogram based on independent prognostic variables for survival prediction. (A) PFS prediction. (B) OS prediction.

Abbreviations: PFS, progression-free survival; OS, overall survival.

Figure 4 ROC curve of the nomogram and Al-mefty classification for survival prediction. (A) 1-year and 3-year PFS. (B) 3-year and 5-year OS.

Abbreviations: ROC, receiver operating characteristic; PFS, progression-free survival; OS, overall survival; AUC, area under the curve.

Figure 5 The nomogram showed adequate performance in survival prediction. The calibration curves indicated the agreement between the predicted and actual probability of PFS (A) and OS (B). The dashed blue line represents the actual probability of survival, the red dots and red lines represent the probability of survival predicted by the nomogram, and the solid blue lines represent the 95% confidence interval of the probability of survival predicted by the nomogram. Decision curve analysis of the nomogram for PFS (C) and OS (D).

Abbreviations: PFS, progression-free survival; OS, overall survival.