Prognostic Value of the Hemoglobin/Red Cell Distribution Width Ratio in Resected Lung Adenocarcinoma

SIMPLE SUMMARY: Low hemoglobin (Hb) values—indicating a condition of anemia—are related to impaired nutrition and immune system status, suggesting reduced tolerance to therapies in oncologic patients. In fact, it has been shown that pre-treatment anemia predicts poor outcomes in many neoplastic diseases. Similarly, red cell distribution width—which is a measure of the size of variation of circulating erythrocytes—has been shown to be closely related to poor prognosis both in cardiovascular and in oncologic diseases. The use of the Hb-to-red cell distribution width (RDW) ratio (HRR)—which merges data coming from the two blood parameters—is a prognostic marker in esophageal squamous cell carcinoma, small cell lung cancer, and several other types of solid tumors, emerging as an independent prognostic factor for overall survival and disease-free survival. The aim of the present study was to investigate the prognostic role of pre-operative HRR in resected-pulmonary adenocarcinoma patients undergoing a multidisciplinary treatment. ABSTRACT: Background: The ratio of hemoglobin to red cell distribution width (HRR) has been described as an effective prognostic factor in several types of cancer. The aim of this study was to investigate the prognostic role of preoperative HRR in resected-lung-adenocarcinoma patients. Methods: We enrolled 342 consecutive patients. Age, sex, surgical resection, adjuvant treatments, pathological stage, preoperative hemoglobin, red cell distribution width, and their ratio were recorded for each patient. Results: Mean age was 66 years (SD: 9.0). There were 163 females (47.1%); 169 patients (49.4%) had tumors at stage I, 71 (20.8%) at stage II, and 102 (29.8%) at stage III. In total, 318 patients (93.0%) underwent lobectomy, and 24 (7.0%) pneumonectomy. Disease-free survival multivariable analysis disclosed an increased hazard ratio (HR) of relapse for preoperative HRR lower than 1.01 (HR = 2.20, 95%CI: (1.30–3.72), p = 0.004), as well as for N1 single-node (HR = 2.55, 95%CI: (1.33–4.90), p = 0.005) and multiple-level lymph node involvement compared to N0 for both N1 (HR = 9.16, 95%CI:(3.65–23.0), p < 0.001) and N2 (HR = 10.5, 95%CI:(3.44–32.2, p < 0.001). Conclusion: Pre-operative HRR is an effective prognostic factor of disease-free survival in resected-lung-adenocarcinoma patients, together with the level of pathologic node involvement.