Prognostic significance of combined fibrinogen concentration and neutrophil-to-lymphocyte ratio in patients with resectable non-small cell lung cancer

Objective:Cancer-associated inflammation and coagulation cascades play vital roles in cancer progression and survival.In this study,we investigated the significance of the combination of preoperative fibrinogen and the neutrophil-to-lymphocyte ratio(NLR)in predicting the survival of patients with non-small cell lung cancer(NSCLC).Methods:We retrospectively enrolled 589 patients with NSCLC who underwent surgery.The univariate and multivariate Cox survival analyses were used to evaluate the prognostic indicators,including the combination of fibrinogen and NLR(F-NLR).The cut-off values for fibrinogen,NLR,and clinical laboratory variables were defined by the receiver operating characteristic(ROC)curve analysis.According to the ROC curve,the recommended cut-off values for fibrinogen and the NLR were 3.48 g/L and 2.30,respectively.Patients with both a high NLR(≥2.30)and hyperfibrinogenemia(≥3.48 g/L)were given a score of 2,whereas those with one or neither were scored as 1 or 0,respectively.Results:Our results showed that F-NLR was an independent prognostic indicator for disease-free survival(DFS)[hazard ratio(HR),1.466;95%confidence interval(CI),1.243–1.730;P<0.001]and overall survival(OS)(HR,1.512;95%CI,1.283–1.783;P<0.001).The five-year OS rates were 66.1%,53.5%,and 33.3%for the F-NLR=0,F-NLR=1,and F-NLR=2,respectively(P<0.001).Correspondingly,their five-year DFS rates were 62.2%,50.3%,and 30.4%,respectively(P<0.001).In the subgroup analyses of the pathological stages,the F-NLR level was significantly correlated with DFS and OS in stage I and IIIA cancers.Conclusions:Preoperative F-NLR score can be used as a valuable prognostic marker for patients with resectable early-stage NSCLC.

术前红细胞分布宽度对非小细胞肺癌患者预后的评估价值

目的:分析术前红细胞分布宽度(red cell distribution width,RDW)对非小细胞肺癌(non-small cell lung cancer,NSCLC)患者预后的评估价值。方法:回顾性分析2008年3月至2012年12月天津医科大学肿瘤医院行根治性手术的513例NSCLC患者的临床病理资料。根据受试者工作特征ROC曲线分析确定RDW的截断值。分别通过χ2、t或秩和检验分析RDW与临床病理特征和实验室变量之间的关系,采用Kaplan-Meier法进行生存分析,Log-rank检验组间生存差异。采用Cox比例风险回归模型进行多因素分析。结果:根据ROC曲线,术前RDW最佳截断值为12.95%。其中RDW≤12.95%为250例,RDW>12.95%为263例。术前RDW与年龄、血红蛋白、白蛋白、纤维蛋白原和D-二聚体水平显著相关(均P<0.05)。单因素分析显示肿瘤位置、病理分期、血小板数目、白蛋白、血红蛋白、纤维蛋白原和术前RDW是影响NSCLC患者预后的因素(均P<0.05);多因素分析显示术前RDW和病理分期是影响NSCLC患者预后的独立危险因素(均P<0.05)。结论:术前RDW水平可作为预测行根治性手术的NSCLC患者预后的指标。