PONE-D-20-13045

The value of red blood cell distribution width, neutrophil-to-lymphocyte ratio, and hemoglobin-to-red blood cell distribution width ratio in the progression of non-small cell lung cancer

PLOS ONE

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Reviewer #1: Partly

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: This manuscript reports the value of several hematologic parameters in the progression of non-small cell lung cancer (NSCLC). Red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and hemoglobin-to-red blood cell distribution (HRR) values were evaluated in 245 patients with NSCLC, and compared to 97 patients with benign nodules and to 94 healthy volunteers. Results showed that RDW, NLR, and HRR could be used to distinguish patients with NSCLC from healthy controls. Furthermore, NLR and HHR could be used to distinguish between patients with NSCLC and benign nodules, while RDW can be used for distinguishing the NSCLC group at III-IV stage. As these 3 parameters are available in any hematology analyzer, and are fast and cheap to obtain, the information reported in this study can be very useful for those studying new diagnostic tools to predict cancer progression and prognosis. Therefore, I think this manuscript merits publication in Plos One. In the following, authors can find minor comments that can help to improve the quality of the manuscript:

- Page 10: “The healthy volunteers had no acute and chronic infectious diseases; no vital organ diseases. such as heart, liver, kidney and digestive system diseases”. Please, remove point before “such”.

- Tables 1, 2 and 3. Please correct the typographical error in “smoking history”.

- Page 12: “Leukocyte count, neutrophil count, lymphocyte count, hemoglobin, and CEA in patients with NSCLC were significantly higher than those in patients with benign lung nodules and healthy controls”. Please, correct the sentence. Lymphocyte count and hemoglobin are lower among patients with NSCLC, which is the primary reason why NLR is high and HRR is low for these patients.

- I recommend the authors to include either the percentage of patients with abnormal hematological parameters in Table 2, or to include the normal values of these parameters in the table (as another column titled normal range).

- Hemoglobin normal range varies with gender and smoking status. Proof of this is that the only parameter correlated to smoking history and gender is HRR (none of the other 2 parameters are correlated to these clinical characteristics). I wonder if the authors can safely apply this parameter as a diagnostic tool independently of gender and smoking history. Please, discuss this issue.

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Reviewer #1: No

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The value of red blood cell distribution width, neutrophil-to-lymphocyte ratio, and hemoglobin-to-red blood cell distribution width ratio in the progression of non-small cell lung cancer

PONE-D-20-13045R1

Dear Dr. Wu,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Jeffrey Chalmers, Ph.D.

Academic Editor

PLOS ONE

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