Role of Hb to RDW ratio in metastatic renal cell carcinoma patients treated with first-line immunotherapy combinations

Immunotherapy. 2025 Jan;17(1):25-35. doi: 10.1080/1750743X.2025.2452145. Epub 2025 Jan 20.

Abstract

Background: The present study aimed to investigate the prognostic and predictive roles of Hb/RDW ratio in patients with mRCC treated with first-line immunotherapy combinations (TKI plus ICI or ICI plus ICI).

Materials and methods: We performed a sub-analysis of a multicenter retrospective observational study (ARON-1 project) involving patients with mRCC treated with first-line immunotherapy combinations.

Results: Three hundred and twenty-nine patients were enrolled, 244 males and 85 females. Median age was 65.5 years. The prognostic impact of the Hb/RDW ratio on PFS and OS was observed in the whole population examined. Hb/RDW ratio had a correlation with neutrophil-to-lymphocyte ratio (NLR), a blood inflammatory parameter.

Conclusion: Hb/RDW ratio is a new inflammatory prognostic factor, easy to use in daily clinical practice.

Keywords: NLR; Prognostic score; RDW; hemoglobin; immune checkpoint inhibitors; metastatic renal cell carcinoma; ratio; tyrosine-kinase inhibitors.

Plain language summary

This study examined patients with advanced kidney cancer treated with immunotherapy combinations, focusing on the Hb/RDW ratio, a simple measure from routine blood tests comparing hemoglobin levels to red blood cell size variation. The findings showed that patients with a lower Hb/RDW ratio had shorter survival. This suggests that the Hb/RDW ratio could be a useful tool for predicting patient outcomes. The ratio’s association with inflammation, which is known to influence cancer progression, may explain its significance. The hope is that the Hb/RDW ratio could help doctors make better treatment decisions for patients with advanced kidney cancer.

Publication types

  • Observational Study
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Renal Cell* / blood
  • Carcinoma, Renal Cell* / drug therapy
  • Carcinoma, Renal Cell* / mortality
  • Carcinoma, Renal Cell* / therapy
  • Erythrocyte Indices
  • Female
  • Hemoglobins* / analysis
  • Hemoglobins* / metabolism
  • Humans
  • Immune Checkpoint Inhibitors* / therapeutic use
  • Immunotherapy* / methods
  • Kidney Neoplasms* / blood
  • Kidney Neoplasms* / drug therapy
  • Kidney Neoplasms* / mortality
  • Kidney Neoplasms* / therapy
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies

Substances

  • Hemoglobins
  • Immune Checkpoint Inhibitors