Survival Impact of Preoperative Hemoglobin-to-Red Cell Distribution Width Ratio in Stage I Gastric Cancer Treated with Curative Surgery.

Introduction: The determinants of survival in early-stage gastric cancer (GC), where long-term outcomes are often driven more by non-cancer-related factors than by tumor biology, remain insufficiently defined. We hypothesized that the hemoglobin-to-red cell distribution width ratio (HRR) may serve as a useful prognostic indicator in this setting and evaluated its association with long-term outcomes in stage I GC. Methods: We retrospectively reviewed the clinicopathological data of 120 consecutive patients with pathological stage I GC who underwent R0 surgical resection. The prognostic value of HRR was assessed using time-dependent receiver operating characteristic analysis and Cox proportional hazards regression. Optimal cutoff values were determined using X-tile software. Results: Time-dependent receiver operating characteristic analyses demonstrated that HRR consistently yielded higher areas under the curve for overall survival (OS) than the prognostic nutritional index during the first four years after surgery, indicating superior discriminatory performance. In univariate Cox regression analysis, preoperative HRR was significantly associated with OS. In multivariate models adjusted for clinicopathological covariates, low preoperative HRR (≤0.183) remained independently associated with poorer OS (hazard ratio, 8.87; 95% confidence interval, 2.84-27.7; p < 0.001), and this association persisted when HRR was treated as a continuous variable. Conclusions: Preoperative HRR was a robust prognostic marker for OS in patients undergoing curative surgery for stage I GC. Given its simplicity and accessibility, HRR may represent a practical tool for mortality risk stratification in early-stage GC, a population in which non-cancer-related factors substantially influence survival outcomes.