Evaluation of the prognostic utility of the hemoglobin-to-red cell distribution width ratio in head and neck cancer

PurposeHemoglobin is a known prognostic marker in many cancers, including head and neck cancer (HNC). There is some evidence that the red cell distribution width, which is an index of variation in size of red blood cells (RBCs), might be associated with prognosis as well. Recently, a novel prognostic biomarker has been reportedthe ratio of the hemoglobin-to-red cell distribution width (Hb/RDW). Our objective was to evaluate the prognostic utility of the pretreatment Hb/RDW in HNC, controlled with known prognostic indices.MethodsRetrospective cohort study in a tertiary academic hospital setting. Patients diagnosed with HNC treated with curative-intent surgery were eligible. Metastatic disease was excluded. The variables collected were age, sex, BMI, alcohol/tobacco exposure, performance scores, ACE-27, tumor characteristics, adjuvant treatment, and lab values. The primary endpoints were event-free survival (EFS) and overall survival (OS). OS was defined as time from start of treatment to death from any cause, and EFS was defined as time from start of treatment to any progression, recurrence, or death from any cause. Univariate and multivariate survival analysis was performed on the primary endpoints.ResultsA total of 205 patients were enrolled from 2010 to 2016. In multivariate analysis, the factors independently associated with EFS were BMI (p=0.0364), advanced T stage (p=0.001), and low Hb/RDW ratio (p=0.017). The factors independently associated with OS were ECOG score (p=0.042), advanced T stage (p<0.0001), positive nodes (p=0.0195), and Hemoglobin (0.0134).ConclusionA low Hb/RDW ratio was associated with poorer EFS (HR=2.02, 95% CI 1.13-3.61, p=0.017), but was not associated with OS. This is the first study reporting the prognostic utility of Hb:RDW in head and neck cancer.