Increased ratio of red cell distribution width to lymphocyte percentage as a new preoperative marker for unfavorable survival outcomes in upper tract urothelial carcinoma

Yi-Chia Hsieh; Tsung-Han Cheng; Chu-An Wang; Che-Yuan Hu; Wen-Horng Yang; Chien-Hui Ou; Hau-Chern Jan

doi:10.3892/br.2024.1910

Increased ratio of red cell distribution width to lymphocyte percentage as a new preoperative marker for unfavorable survival outcomes in upper tract urothelial carcinoma

Biomed Rep. 2024 Dec 10;22(2):32. doi: 10.3892/br.2024.1910. eCollection 2025 Feb.

Authors

Yi-Chia Hsieh¹, Tsung-Han Cheng^{1

2}, Chu-An Wang³, Che-Yuan Hu^{1

4

5}, Wen-Horng Yang^{1

4}, Chien-Hui Ou^{1

4}, Hau-Chern Jan^{1

2

5}

Affiliations

¹ Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan, R.O.C.
² Division of Urology, Department of Surgery, National Cheng Kung University Hospital Dou-Liou Branch, Yunlin 64043, Taiwan, R.O.C.
³ Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan, R.O.C.
⁴ Department of Urology, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan, R.O.C.
⁵ Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan, R.O.C.

Abstract

The aim of the present study was to determine the prognostic significance of a novel marker, the red cell distribution width to lymphocyte percentage (RDW-to-LYM%) ratio, in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). The clinical and follow-up data of 625 patients with UTUC receiving RNU were retrospectively analyzed. The optimal cut-off value of the pre-treatment RDW-to-LYM% ratio was determined as 0.80 using receiver operating characteristic (ROC) analysis according to cancer-specific death. The associations between low (≤0.80) and high (>0.8) RDW-to-LYM% ratio and other clinicopathological parameters were evaluated using the χ² test and logistic regression analysis. The impact of the RDW-to-LYM% ratio on overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS) rates was assessed using the Kaplan-Meier method and Cox regression analysis. A high RDW-to-LYM% ratio (>0.80) was significantly associated with impaired kidney function, previous/concurrent bladder cancer, tumors involving both the pelvis and ureter, advanced pathological T stage, lymph node involvement and lymphovascular invasion (LVI). Kaplan-Meier analysis revealed that a high RDW-to-LYM% ratio was associated with poorer OS, CSS and PFS than a low RDW-to-LYM% ratio (all P<0.001). The multiple logistic regression analysis revealed that high RDW-to-LYM% ratio was associated with non-organ-confined (NOC) disease [odd ratio (OR), 2.107; 95% confidence interval (CI), 1.446-3.069; P<0.001] and positive LVI (OR, 1.978; 95% CI, 1.338-2.916; P<0.001). Furthermore, the multivariate analysis showed that the RDW-to-LYM% ratio was an independent factor for predicting OS [hazard ratio (HR), 2.046; P<0.001], CSS (HR, 2.041; P<0.001) and PFS (HR, 1.502; P=0.009). In conclusion, the pre-treatment RDW-to-LYM% ratio was found to be a significant predictor of both NOC and the presence of LVI in patients with UTUC. Moreover, an elevated pre-treatment RDW-to-LYM% ratio was identified as an independent factor for unfavorable survival outcomes in patients with UTUC undergoing RNU.

Keywords: outcomes; red cell distribution width to lymphocyte percentage ratio; upper tract urothelial carcinoma.

Grants and funding

Funding: No funding was received.