Hemoglobin-to-red cell distribution width ratio as a practical prognostic tool in second-line immunotherapy for non–small cell lung cancer

Gökhan Şahin; Caner Acar; Salih Tünbekici; Haydar Çağatay Yüksel; Fatma Pınar Açar; Pınar Gürsoy

doi:10.19161/etd.1849122

TR EN

Küçük hücre dışı akciğer kanserinde ikinci basamak immünoterapide hemoglobin–eritrosit dağılım genişliği oranının pratik bir prognostik belirteç olarak değeri

Öz

Amaç: İkinci basamak nivolumab alan metastatik küçük hücreli dışı akciğer kanseri (KHDAK) hastalarında, tedavi öncesi hemoglobin/kırmızı hücre dağılım genişliği oranının (HRR) progresyonsuz sağkalım (PFS) ve genel sağkalım (OS) üzerindeki prognostik değerini değerlendirmek. Gereç ve Yöntem: Metastatik KHDAK tanılı ve ikinci basamak nivolumab tedavisi alan hastalar retrospektif olarak incelendi. Hemoglobin (g/dL) ve RDW (%) tedavi başlangıcından önce ölçülerek HRR (Hb/RDW) hesaplandı. Önceden tanımlı eşik değere göre hastalar düşük HRR (<0,7) ve yüksek HRR (≥0,7) gruplarına ayrıldı. PFS ve OS Kaplan–Meier yöntemiyle analiz edildi; prognostik faktörler Cox regresyon modelleri ile değerlendirildi. Bulgular: Toplam 114 hasta analize dahil edildi. Medyan hemoglobin, RDW ve HRR sırasıyla 11,2 g/dL, %15,4 ve 0,74 idi. Hastaların %57,9’u düşük HRR grubundaydı. Medyan PFS 4,0 ay olup, yüksek HRR grubunda PFS anlamlı olarak daha uzundu (6,5 vs 3,2 ay; p=0,011). Çok değişkenli analizde ECOG performans durumu ≥2, ≥3 metastatik odak ve düşük HRR, daha kısa PFS ile bağımsız olarak ilişkiliydi (HRR: HR=2,00; p=0,007). Medyan OS 10,0 ay olup, yüksek HRR grubunda OS belirgin olarak daha uzundu (18,7 vs 6,0 ay; p<0,001). Düşük HRR, OS için bağımsız kötü prognostik faktör olarak saptandı (HR=2,87; p<0,001). Sonuç: Tedavi öncesi düşük HRR, ikinci basamak nivolumab alan ileri/metastatik KHDAK hastalarında daha kötü sağkalım ile ilişkili, pratik ve düşük maliyetli bir prognostik belirteçtir.

Anahtar Kelimeler

Hemoglobin-to-red cell distribution width ratio as a practical prognostic tool in second-line immunotherapy for non–small cell lung cancer

Abstract

Aim: To evaluate the prognostic value of baseline hemoglobin-to–red cell distribution width ratio (HRR) for progression-free survival (PFS) and overall survival (OS) in patients with advanced or metastatic non–small cell lung cancer (NSCLC) receiving second-line nivolumab. Materials and Methods: Patients with advanced or metastatic NSCLC treated with second-line nivolumab were retrospectively analyzed. Baseline hemoglobin (g/dL) and RDW (%) were obtained prior to treatment initiation, and HRR (Hb/RDW) was calculated. Patients were categorized into low (<0.7) and high (≥0.7) HRR groups using a predefined cutoff. Survival outcomes were assessed using the Kaplan–Meier method, and prognostic factors were evaluated using Cox proportional hazards regression models. Results: A total of 114 patients were included. Median baseline hemoglobin, RDW, and HRR were 11.2 g/dL, 15.4%, and 0.74, respectively; 57.9% of patients had low HRR. Median PFS was 4.0 months, and patients with high HRR had significantly longer PFS than those with low HRR (6.5 vs 3.2 months; p=0.011). In multivariate analysis, ECOG performance status ≥2, ≥3 metastatic sites, and low HRR independently predicted shorter PFS (low HRR: HR=2.00; p=0.007). Median OS was 10.0 months, with significantly longer OS observed in the high HRR group (18.7 vs 6.0 months; p<0.001). Low HRR remained an independent adverse prognostic factor for OS (HR=2.87; p<0.001). Conclusion: Baseline HRR is a simple, inexpensive, and independent prognostic marker associated with inferior survival outcomes in advanced or metastatic NSCLC patients treated with second-line nivolumab.

Keywords

Destekleyen Kurum

Bu çalışma herhangi bir kamu, ticari veya kâr amacı gütmeyen kuruluş tarafından desteklenmemiştir.

Etik Beyan

Bu çalışma, Ege Üniversitesi Tıp Fakültesi Tıbbi Araştırmalar Etik Kurulu tarafından onaylanmıştır (Karar No: 25-12T/4, Tarih: 04.12.2025). Çalışmanın retrospektif tasarımı nedeniyle bilgilendirilmiş onam alınmamıştır. Araştırma, Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüştür.

Teşekkür

Uygulanamaz.

Kaynakça

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Ayrıntılar

Birincil Dil

İngilizce

Konular

Klinik Onkoloji

Bölüm

Araştırma Makalesi

Yazarlar

Gökhan Şahin ^*
0000-0003-1478-9383
Türkiye

Caner Acar
0000-0002-9782-6807
Türkiye

Salih Tünbekici
0000-0001-8804-7636
Türkiye

Haydar Çağatay Yüksel
0000-0001-8857-2983
Türkiye

Fatma Pınar Açar
0009-0000-2749-8732
Türkiye

Pınar Gürsoy
0000-0003-1392-6753
Türkiye

Yayımlanma Tarihi

9 Mart 2026

Gönderilme Tarihi

29 Aralık 2025

Kabul Tarihi

3 Ocak 2026

Yayımlandığı Sayı

Yıl 2026 Cilt: 65 Sayı: 1

DOI

https://doi.org/10.19161/etd.1849122

IZ

https://izlik.org/JA65LY88SF

Kaynak Göster

RIS / Bibtex

Vancouver

1.Gökhan Şahin, Caner Acar, Salih Tünbekici, Haydar Çağatay Yüksel, Fatma Pınar Açar, Pınar Gürsoy. Hemoglobin-to-red cell distribution width ratio as a practical prognostic tool in second-line immunotherapy for non–small cell lung cancer. ETD. 01 Mart 2026;65(1):131-8. doi:10.19161/etd.1849122