Clinical significance of preoperative red cell distribution width-to-albumin ratio in predicting survival after curative surgery for gastric cancer: a retrospective cohort study

Background: Reliable methods for survival risk stratification in gastric cancer (GC) remain limited. We evaluated the prognostic utility of preoperative red cell distribution width (RDW) and the RDW-to-albumin ratio (RAR) in patients undergoing curative surgery for GC. Materials and Methods: Clinicopathological data from 214 consecutive patients who underwent R0 resection for GC were retrospectively analyzed. The prognostic significance of RDW and RAR was assessed using time-dependent receiver operating characteristic (ROC) curves and Cox proportional hazards regression. Optimal cutoff values were determined with X-tile software. Results: Time-dependent ROC analyses demonstrated that RAR consistently yielded higher areas under the curve than RDW for predicting relapse-free survival (RFS), indicating superior discriminatory capacity. In univariate Cox analyses, both RDW and RAR were significantly associated with overall survival (OS) and RFS. Multivariate analyses confirmed that elevated RDW independently predicted poorer OS (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.11–3.08, P = 0.019) and RFS (HR 1.67, 95% CI 1.03–2.71, P = 0.039). Similarly, elevated RAR independently predicted worse OS (HR 1.77, 95% CI 1.06–2.94, P = 0.029) and RFS (HR 1.76, 95% CI 1.07–2.89, P = 0.025). Conclusions: Preoperative RAR, together with RDW, serves as an independent prognostic marker for long-term outcomes in patients with resectable GC. These easily available markers may represent more reliable and practical tools for mortality risk stratification for GC in clinical practice.