Impact of jaundice-induced elevated red blood cell distribution width on survival outcomes in pancreatic cancer patients: a retrospective cohort study.

BACKGROUND

To investigate the clinical significance of jaundice-related elevation in red cell distribution width (RDW) for predicting survival outcomes in patients with pancreatic cancer.

METHODS

We established a multi-etiology cohort of 611 patients. Patients were stratified according to the underlying etiology and RDW status. We examined correlations between RDW and markers of inflammation, nutritional status, and bilirubin levels. We evaluated the independent prognostic impact of the "jaundice-high RDW" phenotype. This phenotype was defined as total bilirubin > 17.1 µmol/L, combined with RDW-CV > 15.4% or RDW-SD > 46 fL. We assessed survival in pancreatic cancer patients using Kaplan-Meier survival analysis with the log-rank test. We also used univariate and multivariate Cox proportional hazards models. Receiver operating characteristic (ROC) analysis was performed to assess the ability of total bilirubin to predict high RDW-CV and high RDW-SD status.

RESULTS

RDW levels showed distinct distributions across different causes of jaundice; malignant obstructive jaundice, including pancreatic cancer, was associated with markedly higher RDW. In patients with pancreatic cancer, RDW was strongly positively correlated with total bilirubin (r > 0.7). Across tumor stages, patients with the "jaundice with high RDW" phenotype had the shortest median survival (5.6 months) and a substantially increased risk of death (HR = 3.52). Bilirubin demonstrated excellent discriminatory performance for high RDW status (AUC > 0.93).

CONCLUSION

In pancreatic cancer, the combination of jaundice and high RDW constitutes a simple and practical tool for risk stratification. Patients presenting with both jaundice and elevated RDW should be prioritized in clinical management, and more intensive, comprehensive therapeutic strategies should be considered to improve outcomes. This study provides readily applicable clinical parameters for precision prognostic assessment in pancreatic cancer.