Prognostic value of the preoperative hemoglobin-to-RDW ratio in endometrial cancer: a retrospective cohort study.

AIMS: The hemoglobin-to-red cell distribution width ratio (Hb/RDW) is a prognostic biomarker in various malignancies. However, its prognostic value in endometrial cancer (EC) remains unclear. This study investigated the association between preoperative Hb/RDW ratio and 5-year overall survival (OS) in patients with EC. MATERIALS & METHODS: This retrospective cohort study included 548 patients with histologically confirmed EC who underwent surgery at a single tertiary center in Taiwan between 2010 and 2021. Patients were stratified on the basis of an Hb/RDW threshold of 1.0, which was derived from receiver operating characteristic curve analysis. Propensity score matching (1:1) and multivariate Cox regression were performed to identify the aforementioned association. RESULTS: Patients with an Hb/RDW ratio of < 1 had significantly poorer 5-year OS than did those with an Hb/RDW ratio of ≥ 1 (adjusted HR: 2.15; 95% CI: 1.19-3.89; p = 0.012). The association between preoperative Hb/RDW ratio and 5-year OS persisted even after propensity score matching (adjusted HR: 2.33; 95% CI: 1.20-4.55; p = 0.013). CONCLUSIONS: The present study highlights the preoperative Hb/RDW ratio as a readily available, cost-effective biomarker with independent prognostic value in EC. This ratio may be incorporated into preoperative risk models to optimize clinical decision-making.