AccScience Publishing / Bladder / Online First / DOI: 10.14440/bladder.0317
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RESEARCH ARTICLE

Prognostic significance of red cell distribution width in bladder cancer: A retrospective analysis

Raul-Dumitru Gherasim1,2 ,  Daniel Porav-Hodade1,2* ,  Călin Chibelean1,2 ,  Laurian-Ștefan Maxim3 ,  Rareș-Florin Vascul2 ,  Alexandru Laslo1,2 ,  Sabin-Octavian Tătaru4 ,  Orsolya Katalyn Ilona Martha1,2
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1 Department of Urology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureș, Transylvania 540142, România
2 Department of Urology, Târgu Mureș Clinical Hospital, Târgu Mureș, Transylvania 540072, România
3 Department of Urology, Brașov Emergency Clinical Hospital, Brașov, Transylvania 500365, România
4 Department of Anatomy, Surgery and Anesthesiology and Intensive Care, Faculty of Medicine, University Dimitrie Cantemir, Târgu Mureș, Transylvania 540545, România
Bladder, e21200075 https://doi.org/10.14440/bladder.0317
Submitted: 26 September 2025 | Revised: 15 October 2025 | Accepted: 4 November 2025 | Published: 3 December 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Background: Bladder cancer (BC) remains a major global health concern because of its high recurrence and mortality rates. Accessible and reliable prognostic markers are crucial for improving patient outcomes. Red cell distribution width (RDW), a widely available parameter, has shown prognostic value in various malignancies, but its role in BC remains underexplored. Objective: This study aims to evaluate the association between pre-operative RDW and key clinicopathological features in BC, including tumor stage, grade, and overall survival, to assess its potential as an independent prognostic marker. Methods: We analyzed 125 patients diagnosed with BC between January and June 2021. Clinical and pathological data were recorded, and RDW was measured before the initial transurethral resection of the bladder tumor. The primary outcome was overall survival. Receiver operating characteristic curve analysis determined the optimal RDW threshold, and multivariate logistic regression assessed its independent prognostic value. Results: The median RDW was 14.0%. A cut-off value of 13.95% predicted mortality (area under the curve: 0.76; sensitivity: 80.4%, specificity: 65.8%), and patients with RDW ≥13.95% showed significantly higher mortality (p<0.001). Elevated RDW remained an independent predictor of death after adjusting for confounders (odds ratio: 1.205; 95% confidence interval: 1.025–1.416; p=0.02). RDW showed no significant association with tumor stage, grade, or gender; however, it correlated modestly with age. Conclusion: Elevated pre-operative RDW is an independent prognostic indicator of mortality in BC patients, reflecting systemic host-related factors rather than tumor-specific features. Given its cost-effectiveness and availability, RDW may serve as a valuable adjunct in the risk-stratification of BC patients.

Keywords
Red cell distribution width
Bladder cancer
Overall survival
Prognostic factor
Funding
None.
Conflict of interest
The authors declare they have no competing interests.
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Bladder, Electronic ISSN: 2327-2120 Print ISSN: TBA, Published by POL Scientific
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