Low Hemoglobin-to-Red Cell Distribution Width Ratio Is Associated with Disease Progression and Poor Prognosis in Upper Tract Urothelial Carcinoma

• Main Authors: Yung-Chun Su, Sheng-Chen Wen, Ching-Chia Li, Hsiao-Chun Su, Hung-Lung Ke, Wei-Ming Li, Hsiang-Ying Lee, Chia-Yang Li, Sheau-Fang Yang, Hung-Pin Tu, Wen-Jeng Wu, Hsin-Chih Yeh
• Format: Article
• Language: English
• Published: MDPI AG 2021-06-01
• Series: Biomedicines
• Subjects: upper tract urothelial carcinoma; white blood cell count; hemoglobin; red blood cell distribution width; progression; prognosis
• Online Access: https://www.mdpi.com/2227-9059/9/6/672

The importance of blood cell markers in patients with malignant tumors has been studied, but there are few studies on the prognostic value of hemoglobin-to-red cell distribution width ratio (HRR) in cancer. This is the first study to investigate the effect of preoperative HRR on patients with upper tract urothelial carcinoma (UTUC). Our retrospective cohort study included 730 UTUC patients who underwent nephroureterectomy from 2000 to 2019. Clinicopathological parameters were compared according to HRR levels, and the relationship between blood cell markers (HRR, white blood cell [WBC] count, platelet count) and prognosis was evaluated using Kaplan–Meier method and Cox regression model. We found that patients with HRR ≤ 1.05 tended to have worse renal function, higher pathological stages, and more high-grade tumors. In univariate analysis, HRR ≤ 1.05, WBC > 8.65 × 10³ cells/μL and platelets >309 × 10³ cells/μL were associated with poor progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Multivariate analysis demonstrated that HRR ≤ 1.05 and WBC > 8.65 × 10³ cells/μL were independent prognostic factors for predicting deterioration of PFS, CSS, and OS. In conclusion, HRR and WBC are easy to obtain in clinical practice and are useful indicators to provide prognostic information before surgery for UTUC.