BACKGROUND: The present study aimed to investigate the prognostic and predictive roles of Hb/RDW ratio in patients with mRCC treated with first-line immunotherapy combinations (TKI plus ICI or ICI plus ICI). MATERIALS AND METHODS: We performed a sub-analysis of a multicenter retrospective observational study (ARON-1 project) involving patients with mRCC treated with first-line immunotherapy combinations. RESULTS: Three hundred and twenty-nine patients were enrolled, 244 males and 85 females. Median age was 65.5 years. The prognostic impact of the Hb/RDW ratio on PFS and OS was observed in the whole population examined. Hb/RDW ratio had a correlation with neutrophil-to-lymphocyte ratio (NLR), a blood inflammatory parameter. CONCLUSION: Hb/RDW ratio is a new inflammatory prognostic factor, easy to use in daily clinical practice.

This study examined patients with advanced kidney cancer treated with immunotherapy combinations, focusing on the Hb/RDW ratio, a simple measure from routine blood tests comparing hemoglobin levels to red blood cell size variation. The findings showed that patients with a lower Hb/RDW ratio had shorter survival. This suggests that the Hb/RDW ratio could be a useful tool for predicting patient outcomes. The ratio’s association with inflammation, which is known to influence cancer progression, may explain its significance. The hope is that the Hb/RDW ratio could help doctors make better treatment decisions for patients with advanced kidney cancer.

Biomedical Centre Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic

Department of Diagnostic and Public Health Section of Pathology University of Verona Verona Italy

Department of Internal Medicine and Medical Specialties University of Genova Genova Italy

Department of Medical Oncology IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori Meldola Italy

Department of Medicine and Surgery Section of Radiology University of Parma Parma Italy

Department of Medicine and Surgery University of Parma Parma Italy

Department of Oncology and Hematology Medical Oncology Unit 1 IRCCS Ospedale Policlinico San Martino Genova Italy

Department of Oncology and Radiotherapeutics Faculty of Medicine and University Hospital in Pilsen Charles University Pilsen Czech Republic

Department of Oncology Portsmouth Hospitals University NHS Trust Portsmouth UK

Faculty of Science and Health School of Pharmacy and Biomedical Sciences University of Portsmouth Portsmouth UK

Medical Oncology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma Italy

Medical Oncology IRCCS Azienda Ospedaliero Universitaria di Bologna Bologna Italy

Medical Oncology Ospedale Santa Corona Pietra Ligure Italy

Medical Oncology Unit Ospedale San Paolo institution Savona Italy

Medical Oncology Unit University Hospital of Parma Parma Italy

Medical Oncology Unit University of Brescia Brescia Italy

Oncology Unit Department of Oncology Istituto Oncologico Veneto IOV IRCCS Padua Italy

Oncology Unit Macerata Hospital Macerata Italy

Pathology Unit University Hospital of Parma Parma Italy

Radiotherapy Unit University Hospital of Parma Parma Italy

Section of biostatistics Department of Health Sciences University of Genova Genova Italy

Translational and Clinical Research Institute Centre for Cancer Newcastle University Newcastle upon Tyne UK

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