本综合分析旨在阐明食管癌食管切除术前红细胞分布宽度（RDW）偏高如何反映不良预后的机制。几项队列研究已经报道，术前RDW可能是食管切除术后不良预后的预测标志物；然而，这种关系的潜在机制尚未阐明。本研究包括于2005年4月至2020年11月间接受食管切除术的626例食管癌患者。采用前瞻性录入的机构临床数据库和最新的随访数据，对术前RDW与临床病理特征、血液数据、短期预后和预后之间的关联进行了回顾性调查分析。在626例患者中，87例（13.9%）术前RDW较高。高RDW与多个不利的特征相关，包括身体状况、美国麻醉师学会物理状态、呼吸道合并症和营养状况。同样，高RDW与术后并发症频繁发生（呼吸道并发症和再手术；P = 0.022和0.034，分别）、辅助化疗机会减少（P = 0.0062）和非食管癌死亡率增加（P = 0.046）相关。最后，RDW可以是食管切除术后生存的独立预测因子（风险比为1.47；95%置信区间为1.009-2.148；P = 0.045）。高术前RDW反映了各种不良背景，并可作为食管癌患者食管切除术后预后不良的替代标志物。版权 © 2022 作者。 Wolters Kluwer Health, Inc.出版。

This comprehensive analysis aimed to elucidate the mechanism underlying how high pretreatment red blood cell distribution width (RDW) reflects poor prognosis after esophagectomy for esophageal cancer.Several cohort studies have reported that preoperative RDW might be a predictive marker for poor prognosis after esophagectomy; however, the underlying mechanism of this relationship has not been elucidated.This study included 626 patients with esophageal cancer who underwent esophagectomy between April 2005 and November 2020. A retrospective investigation of the association between pretreatment RDW and clinicopathological features, blood data, short-term outcomes, and prognosis was conducted using a prospectively entered institutional clinical database and the latest follow-up data.Of 626 patients, 87 (13.9%) had a high pretreatment RDW. High RDW was significantly associated with several disadvantageous characteristics regarding performance status, the American Society of Anesthesiologists physical status, respiratory comorbidity, and nutritional status. Similarly, high RDW correlated with frequent postoperative morbidities (respiratory morbidity and reoperation; P = 0.022 and 0.034, respectively), decreased opportunities for adjuvant chemotherapy (P = 0.0062), and increased death from causes other than esophageal cancer (P = 0.046). Finally, RDW could be an independent predictor of survival after esophagectomy (hazard ratio, 1.47; 95% confidence interval, 1.009-2.148; P = 0.045).High pretreatment RDW reflected various adverse backgrounds and it could be a surrogate marker of poor prognosis in patients who have undergone esophagectomy for esophageal cancer.Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.