Prognostic Value of Chemotherapy-Related Mean Corpuscular Hemoglobin (MCH) Kinetics in Patients with Non-Small Cell Lung Cancer Receiving Adjuvant Chemotherapy

• Nutrition-related indexes are associated with survival in many tumors. • Lower baseline HGB and HCT were associated with poorer DFS in NSCLC patients receiving adjuvant chemotherapy. • MCV and MCH reductions after adjuvant chemotherapy were correlated with a longer DFS. • MCH reduction was identified as an independent prognostic factor for a better DFS. The relationship of nutrition-related indexes kinetics and the survival in patients with non-small cell lung cancer (NSCLC) receiving adjuvant chemotherapy is unclear. To investigate the association between changes in nutritional indices at 4 weeks after completion of adjuvant chemotherapy and disease-free survival (DFS) in patients with completely resected NSCLC. The 195 patients with NSCLC who accepted radical surgery and postoperative chemotherapy were identified in this retrospective single-center cohort study. Longitudinal blood samples were collected before and after adjuvant chemotherapy to measure nine nutritional indexes, including red blood cell (RBC), hemoglobin (HGB), mean corpuscular volume (MCV), hematocrit (HCT), mean corpuscular hemoglobin (MCH), total protein (TP), albumin (ALB), globulin (GLOB), and albumin to globulin ratio (AGR). Cox proportional hazards regression models were used to analyze the prognostic factors for DFS. There were significant variations in HGB, MCV, HCT and MCH in post-adjuvant chemotherapy patients with NSCLC. Lower baseline HGB and HCT were associated with unfavorable DFS. Besides, patients with decreasing MCV and MCH at 4 weeks after adjuvant chemotherapy exhibited superior DFS. Univariate and multivariate analyses identified the chemotherapy-related MCH reduction (HR=0.502, 95% CI:0.287–0.877, P = 0.015) as an independent prognostic factor associated with favorable DFS. MCH reduction at 4 weeks after adjuvant chemotherapy was associated with improved DFS in NSCLC patients receiving adjuvant chemotherapy. This exploratory finding is hypothesis-generating and requires validation in larger, multicenter prospective studies.