Chronic inflammation is one of the critical causes to promote initiation and metastasis of solid malignancies including lung cancer. Inflammatory biomarkers, fibrinogen (Fib) and albumin (Alb), are significantly correlated with survival of other cancer. Here, we aim to investigate the prognostic roles of Alb to Fib ratio (AFR), Fib and Alb in lung cancer and to establish a novel effective nomogram combined with AFR.
412 lung cancer (LC) patients diagnosed between Feb 2005 and Dec 2014 were recruited in this retrospective study. the survival data were obtained by 3 years’ following-up. The prognostic roles of AFR, Fib, Alb, NLR, PLR and MLR were identified by X-tile software, Kaplan-Meier curve, Cox regression model and time-dependent ROC.
In our study, the optimal cut-off values of AFR, Fib, Alb, NLR, PLR and MLR were 7.8, 3.3 mg/dL, 39.0 g/L, 2.7, 144.0 and 0.2, respectively. Low AFR (adjusted HR = 1.820, 95%CI=1.250-2.652 for LC; adjusted HR = 2.308, 95%CI=1.478-3.606 for NSCLC), high Fib (adjusted HR = 1.575, 95%CI=1.108-2.238 for LC; adjusted HR = 1.892, 95%CI=1.257-2.846 for NSCLC), low Alb (adjusted HR = 1.524, 95%CI=1.157-2.006 for LC; adjusted HR = 1.811, 95%CI=1.326-2.474 for NSCLC) were significantly associated with increased risk of death for LC patients, especially for NSCLC patients in all stages; high NLR was obviously associated with poor survival in LC individuals (adjusted HR = 1.405, 95%CI=1.066-1.852), particularly NSCLC (adjusted HR = 1.552, 95%CI=1.129-2.133) and TNM IV stage (adjusted HR = 1.92, 95%CI=1.201-3.071) patients, and high PLR (adjusted HR = 1.391, 95%CI=1.064-1.820 for LC; adjusted HR = 2.186, 95%CI=1.186-4.033 for TNM IV stage) was significantly increased risk of death for advanced stage LC patients. Moreover, the area under curves (AUCs) within AFR, Fib, NLR were higher than that within Alb and PLR for prediction of survival of NSCLC patients; c-index of predicted nomogram for NSCLC including AFR was higher than that without these additional parameters (c-index= 0.731 vs.0.719).
Our findings demonstrated that circulating pre-treatment AFR was a promising prognostic biomarker to improve the predicted efficacy of nomogram for NSCLC.
Clinical trial identification
Legal entity responsible for the study
The Ethical Committees of the two hospitals The second Affiliated Hospital of Nanchang University (Jiangxi, China) and The first Affiliated Hospital of Nanchang University (Jiangxi, China).
The National Natural Science Foundation of China under Grant (No. 81360083, No. 81271912 and No. 81560033); and 2016 Jiangxi Province Postgraduate Innovation Special Fund under Grant (No. YC2016-S057).
All authors have declared no conflicts of interest.