Prognostic value of hemoglobin-to-red cell distribution width ratio and inflammation markers in colorectal cancer

Abstract

BACKGROUND

The hemoglobin-to-red cell distribution width ratio (HRR) is a recently introduced, easily accessible marker that provides insights into inflammation and the tumor vascular microenvironment. It has been suggested to have prognostic value for overall survival in various types of cancer, including urothelial carcinoma, lung cancer, and hepatocellular carcinoma. It has not yet been sufficiently investigated in colorectal cancers (CRC).

AIM

To investigate the prognostic significance of the HRR and other inflammation-based hematological markers in patients with metastatic CRC. Additionally, the study evaluated the impact of surgical interventions, particularly metastasectomy, and multiple clinical and laboratory parameters on overall survival. By identifying low-cost, accessible prognostic indicators, this research seeks to support clinicians in optimizing treatment strategies and risk stratification for patients with CRC.

METHODS

In this retrospective study, patients diagnosed with CRC between January 2020 and December 2024 were analyzed. The impact of HRR in conjunction with inflammatory markers and a total of 22 different clinical and laboratory parameters on overall survival were evaluated using univariate Cox regression and a multivariate model. Survival curves were visualized using Kaplan-Meier analysis.

RESULTS

A total of 155 patients with CRC were included in the study. The median age was 60 years, and 61.9% presented with de novo metastasis. In the receiver operating characteristic curve and area under the curve analysis performed to determine the optimal cutoff, the values were found to be 6.10 for carcinoembryonic antigen (CEA) (P = 0.036), 18.85 for platelet-to-red cell distribution width ratio (P = 0.028), and 10.87 for platelet distribution width-to-lymphocyte ratio (P = 0.028). For neutrophil-to-lymphocyte ratio, systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio, HRR, and carbohydrate antigen 19-9, an optimal cutoff could not be determined using the receiver operating characteristic-area under the curve analysis. Therefore, the median values were adopted as the cutoffs (3.09, 835.96, 177.50, 0.380, 0.824, and 21.6, respectively). Univariate analysis identified male gender (P = 0.045), being under 65 years of age (P = 0.001), history of metastasectomy (P = 0.001), low serum CEA level (P = 0.010), low PLR (P = 0.024), low SII (P = 0.010), and high HRR (P = 0.025) as favorable prognostic factors for overall survival. In the multivariate model, being under 65 years of age [hazard ratio (HR) = 1.59, 95% confidence interval (CI): 1.06-2.39, P = 0.025], metastasectomy (HR = 0.49, 95%CI: 0.29-0.85, P = 0.011), CEA (HR = 1.51, 95%CI: 1.0-2.28, P = 0.048), and PLR (HR = 1.63, 95%CI: 1.09-2.44, P = 0.018) emerged as independent prognostic factors for overall survival, whereas gender, SII, and HRR did not retain statistical significance.

CONCLUSION

In conclusion, low HRR alone was a prognostic indicator. However, when modelled with other inflammatory and clinical parameters, it did not provide a sufficiently strong marker feature.

Keywords: Colon cancer; Neutrophil-to-lymphocyte ratio; Hemoglobin-to-red cell distribution width ratio; Systemic immune-inflammation index; Inflammation markers

Core Tip: Colorectal cancer is a leading cause of cancer-related deaths. While survival can be estimated with special tests, using inexpensive and validated methods such as hemogram parameters may be beneficial for clinicians. Blood parameter scales are currently used for some cancers, but there is not enough data on colorectal cancer. Hemoglobin/red cell distribution width ratio, which combines many parameters such as nutrition and inflammation in the same ratio, may be useful in predicting overall survival.