Cmar_a_251271 5105..5117

*These authors contributed equally to this work Objective: To determine the prognostic value of red cell distribution width (RDW) and circulating tumor cells with epithelial–mesenchymal transition phenotype (M-CTC) in lung adenocarcinoma (LUAD). Patients and Methods: Clinical and laboratory data of 60 patients with LUAD were collected. CTCs were isolated from their peripheral blood using the CanPatrol CTC enrichment method. The indicators of RDW and neutrophil lymphocyte ratio (NLR) were calculated based on the laboratory standards. Results: A total of 60 LUAD patients were enrolled, of which 19 (31.7%) had high RDW (>0.14) and 32 (53.3%) were positive for M-CTCs. There was no significant correlation between RDW and the clinical characteristics. M-CTC was not significantly associated with tumor size and differentiation, age, gender, tumor stage, and histological type but correlated significantly with lymphatic metastasis (P = 0.044), high NLR (>2.26, P = 0.023), and high RDW (>0.14, P = 0.036). Furthermore, the M-CTC LUAD patients had a significantly poor recurrence-free survival (RFS; Log rank P =0.001, HR= 2.749, 95%CI = 1.489–5.078) and overall survival (OS; Log rank P =0.022, HR = 2.283, 95% CI = 1.128–4.622) compared to the M-CTC patients. Similarly, high RDW also correlated with worse RFS (Log rank P = 0.008, HR = 2.331, 95% CI = 1.248–4.353) and OS (Log rank P = 0.004, HR = 0.004, 95% CI = 1.398–5.525). Conclusion: M-CTC is significantly related to RDW and NLR, and an independent prognostic factor in LUAD.