Hemoglobin-to-Red Cell Distribution Width Ratio Independently Predicts Survival in Non-Metastatic Gastric Cancer: A Retrospective Cohort Study.

Background and Objectives: Gastric cancer is one of the most common malignancies worldwide and continues to be associated with high mortality. The hemoglobin-to-red cell distribution width (HGB/RDW) ratio has emerged as a promising hematological prognostic biomarker in various cancers. However, its prognostic significance in patients with curative-intent resection of non-metastatic gastric cancer remains insufficiently investigated. This study aimed to evaluate the association between the pretreatment HGB/RDW ratio and progression-free survival (PFS) as well as overall survival (OS) in patients with non-metastatic gastric cancer. Materials and Methods: In this multicenter study, a total of 175 patients with non-metastatic gastric cancer who received perioperative FLOT chemotherapy (four preoperative and four postoperative cycles) and underwent curative-intent surgical resection were retrospectively analyzed. A cut-off value for the HGB/RDW ratio was calculated using receiver operating characteristic (ROC) curve analysis. Survival outcomes, including progression-free survival (PFS) and overall survival (OS), were analyzed using the Kaplan-Meier method. Multivariate Cox proportional hazards regression analysis was performed to identify independent prognostic factors. Results: Patients with an HGB/RDW ratio > 0.85 demonstrated significantly superior 2-year and 5-year OS rates (76.2% vs. 59.6% and 51.6% vs. 27.7%, respectively; p = 0.003) and PFS rates (69.4% vs. 49.6% and 53.7% vs. 36.4%, respectively; p = 0.047) compared to those with HGB/RDW ≤ 0.85. Multivariate analysis identified HGB/RDW ≤ 0.85 as an independent predictor of both increased mortality risk (HR: 1.88, 95% CI: 1.16-3.06; p = 0.011) and disease progression risk (HR: 1.79, 95% CI: 1.18-2.72; p = 0.006). Conclusions: The pretreatment HGB/RDW ratio is an independent prognostic factor for OS and PFS in patients with curative-intent resection of non-metastatic gastric cancer and may be considered a practical marker that could contribute to treatment planning in this patient population.