The ratio of hemoglobin to red cell distribution width predicts survival in patients with gastric cancer treated by neoadjuvant FLOT: a retrospective study

• Published in: Irish journal of medical science 2020-02, Vol.189 (1), p.91-102
• Main Authors: Yılmaz, Ali, Mirili, Cem, Tekin, Salim Başol, Bilici, Mehmet
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers - metabolism; Erythrocyte Indices; Family Medicine; Female; General Practice; Hemoglobins - metabolism; Humans; Internal Medicine; Leucovorin; Male; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy - methods; Original Article; Retrospective Studies; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - therapy; Survival Analysis
• ISSN: 0021-1265; 1863-4362
• DOI: 10.1007/s11845-019-02153-x

Background Hemoglobin (HB) and red cell distribution width (RDW) are known to be prognostic in many cancer types. The HB-RDW ratio (HRR) is a new biomarker that has been shown to be predictive in some cancer types. However, the prognostic significance of HRR in patients with gastric cancer (GC) is unknown. Aims In this study, we aimed to demonstrate the prognostic importance of HRR in GC patients treated with neoadjuvant fluorouracil, leucovorin, oxaliplatin, docetaxel (FLOT). Methods Eighty-five GC patients who were treated with neoadjuvant FLOT in our center were included in the study, retrospectively. Associations between clinical and histopathological parameters with disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan–Meier curves and compared by the log-rank test. The optimal cutoff values were determined by a receiver operating characteristic (ROC) curve analysis. Neutrophil–lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and HRR were grouped based on a cutoff points 3.05, 802, and 0.89, respectively. Univariate and multivariate analyses were used to assess their prognostic values for DFS and OS. Results Low NLR, low SII, and high HRR were found to be associated with longer DFS/OS. In univariate analysis, Eastern Cooperative Oncology Group performance status, grade, stage, response to neoadjuvant treatment, NLR, SII, and HRR were found to be significantly associated with DFS and OS. But in multivariate analysis, only HRR was demonstrated as an independent prognostic factor for DFS/OS ( p 0.001, p 0.037, respectively). Conclusions HRR is a new biomarker that can predict DFS and OS in GC patients treated with neoadjuvant FLOT.