Survival Analysis of Young Breast Cancer Patients Based on The Number of Red Cell Width Distribution (RDW) at Prof Dr. I.G.N.G Ngoerah Hospital Denpasar

Background: Breast cancer is the most common type of cancer among adolescents and young adults diagnosed in the age range of 15-39 years old and approximately 30% of cancers among women belong to the adolescent and young adult age groups. The prognosis of breast cancer occurring in young women tends to be worse than in old age. Red cell distribution width (RDW) is a routinely examined parameter, and its endpoint is a prognostic marker in solid tumors. Recently, RDW has been increasingly recognized as having an important role in carcinogenesis, tumor progression, and prognosis. Objective: This study aims to identify the number of RDWs that affect the survival of young breast cancer patients and other factors at Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar. Methods: This study used a retrospective cohort design by taking medical records and Cancer Registry data from young breast cancer patients treated at RSUP Prof. Dr. I.G.N.G Ngoerah Denpasar from January 1st, 2017, to January 1st, 2022. Variables studied included the number of RDW pre-treatment, tumor size, lymph node status, metastasis, tumor stage, tumor grading, lymphovascular invasion (LVI), tumor-infiltrating lymphocyte (TIL), and subtype. Result: A total of 160 patients were included in this study. The majority of patients are aged 15-40 years. Median survival for young breast cancer patients is 57 months with low RDW pre-treatment (95% CI 55.08-59.27) and 46 months with high RDW (95% CI 41.53-50.74). Factors associated with the survival of breast cancer patients, age, the tumor stage, and the difference in 5-year survival between Stages I-II, III, and IV 87.0% vs 88.2% vs 42.1% (p<0.05). Tumor grading, LVI, TIL, subtype, and Histopathology type found no significant effect on patient survival. Conclusion: This study suggests that RDW can be a potential early indicator in assessing the prognosis of young breast cancer, especially in identifying patients at risk of shorter survival, given that breast cancer at a young age tends to be more aggressive and has a more variable therapeutic response compared to older patients, cheap and easily accessible hematological parameters such as RDW can help in devising more targeted patient management strategies.