Assessing the Predictive Power of the Hemoglobin/Red Cell Distribution Width Ratio in Cancer: A Systematic Review and Future Directions

Background and Objectives: The hemoglobin (Hb)/red cell distribution width (RDW) ratio
has emerged as an accessible, repeatable, and inexpensive prognostic factor that may predict survival
in cancer patients. The focus of this systematic review is to investigate the prognostic role of the
Hb/RDW ratio in cancer and the implications for clinical practice. Materials and Methods: A literature
search of PubMed, Scopus, and Web of Science databases was performed by an independent author
between 18 March and 30 March 2023 to collect relevant literature that assessed the prognostic value
of the Hb/RDW ratio in cancer. Overall survival (OS), progression-free survival (PFS), and the
association of these with the Hb/RDW ratio were considered to be the main endpoints. Results:
Thirteen retrospective studies, including 3818 cancer patients, were identified and involved in this
review. It was observed that, when patients with a high vs. low Hb/RDW ratio were compared, those
with a lower Hb/RDW ratio had significantly poorer outcomes (p < 0.05). In lung cancer patients,
a one-unit increase in the Hb/RDW ratio reduces mortality by 1.6 times, whilst in esophageal
squamous-cell carcinoma patients, a lower Hb/RDW ratio results in a 1.416-times greater risk of
mortality. Conclusions: A low Hb/RDW ratio was associated with poor OS and disease progression in
patients with cancer. This blood parameter should be considered a standard biomarker in clinical
practice for predicting OS and PFS in cancer patients. Future searches will be necessary to determine
and standardize the Hb/RDW cut-off value and to assess whether the Hb/RDW ratio is optimal
as an independent prognostic factor or if it requires incorporation into risk assessment models for
predicting outcomes in cancer patients.