Prognostic significance of pre-resection albumin/fibrinogen ratio in patients with non-small cell lung cancer: A propensity score matching analysis.

Nutrition and coagulation play important roles in cancer progression. This study was aimed to investigate the value of the albumin/fibrinogen ratio (AFR) in non-small cell lung cancer (NSCLC) patients, through a propensity score matching (PSM) method. We retrospectively analyzed 529 NSCLC patients underwent surgical resection from 2010 to 2015. PSM was used to eliminate possible biases. A Cox proportional hazards regression model was performed to evaluate the prognostic value of AFR in NSCLC. The optimal value was 9.67 for the AFR by ROC (receiver operating characteristic) curve. The AFR was statistically significantly associated with age, sex, smoking history, histological subtype, tumor size, pathological stage and adjuvant therapy (p < 0.05). Multivariate analysis indicated that the pathological stage and pre-resection AFR were independent prognostic factors for patients with NSCLC. Additionally, elevated AFR indicated a better outcome, and patients with higher AFR had lower risk for overall death (OS) (HR 0.512, 95% CI 0.316-0.829, p = 0.006) as well as disease-free death (DFS) (HR 0.561, 95% CI 0.399-0.787, p = 0.001). The propensity score model identified 120 patients from each group that were balanced for age, sex, smoking history, histological subtype, tumor size, stage distribution and adjuvant therapy. In multivariable regression analysis of PSM groups, the result indicated that the AFR was predictive for OS (HR 0.392, 95% CI 0.225-0.683, p < 0.001) and DFS (HR 0.526, 95% CI 0.344-0.805, p = 0.003). Pre-resection AFR can be considered as an independent prognostic factor in NSCLC patients, and higher AFR may enhance OS and DFS of NSCLC patients.

Chen S ，Yan H ，Du J ，Li J ，Shen B ，Ying H ，Zhang Y ，Chen S ... -  《-》

Pretreatment albumin/fibrinogen ratio as a promising predictor for the survival of advanced non small-cell lung cancer patients undergoing first-line platinum-based chemotherapy.

Ying J ，Zhou D ，Gu T ，Huang J ，Liu H ... -  《BMC CANCER》

Albumin-to-fibrinogen ratio as a promising biomarker to predict clinical outcome of non-small cell lung cancer individuals.

Chronic inflammation is one of the critical causes to promote the initiation and metastasis of solid malignancies including lung cancer (LC). Here, we aimed to investigate the prognostic roles of albumin (Alb)-to-fibrinogen (Fib) ratio (AFR), Fib and Alb in LC and to establish a novel effective nomogram combined with AFR. Four hundred twelve LC patients diagnosed between February 2005 and December 2014 were recruited in this prospective study. The prognostic roles of AFR, Fib, Alb, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) were identified by X-tile software, Kaplan-Meier curve, Cox regression model, and time-dependent ROC. Pretreatment high circulating Fib, low AFR, and Alb were significantly associated with increased risk of death for LC patients, especially for non-small cell lung cancer (NSCLC) patients in all stages. The area under curves (AUCs) of AFR, Fib, and NLR were higher than them within Alb and PLR for predicting the survival of NSCLC patients. Moreover, we found that clinical outcome of high AFR patient with chemo-radiotherapy was superior to low AFR patient; overall survival rate of stage II-III NSCLC patients undergoing chemo-radiotherapy was significantly lower than the surgical patients with treatment of adjuvant chemo-radiotherapy(P = 0.001) in low AFR subgroup. On the contrary, clinical outcome of the patients receiving chemo-radiotherapy was the same to the patients undergoing surgery and adjuvant chemo-radiotherapy (P = 0.405) in high AFR subgroup. In addition, c-index of predicted nomogram including AFR (0.717) for NSCLC patients with treatment of chemo-radiotherapy was higher than that without AFR (0.707). Our findings demonstrated that circulating pretreatment AFR might be a potential biomarker to predict clinical efficacy of surgical resection and adjuvant chemo-radiotherapy and be a prognostic biomarker for NSCLC individuals.

Li SQ ，Jiang YH ，Lin J ，Zhang J ，Sun F ，Gao QF ，Zhang L ，Chen QG ，Wang XZ ，Ying HQ ... -  《Cancer Medicine》

Prognostic Value of Preoperative Albumin-to-Fibrinogen Ratio in Patients with Bladder Cancer.

Background: Both nutritional status and coagulation function are closely associated with prognosis in patients with bladder cancer (BC). This study aimed to investigate the prognostic value of albumin-to-fibrinogen ratio (AFR) for BC patients underwent radical cystectomy (RC) or transurethral resection of bladder tumor (TURBT), and develop predictive nomograms based on AFR. Methods: We retrospectively collected medical records of 358 BC patients who underwent RC or TURBT between January 2012 and December 2018. The whole cohort was divided into the training (215 patients, 60.06%) and validation cohorts (143 patients, 39.94%) based on surgery dates. The training cohort was applied to select characteristics and construct nomograms, while the validation cohort was used to verify the nomograms independently. Endpoints of the current study included overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS). Prognostic values of AFR and other characteristics were evaluated using univariate and multivariate Cox regression analyses and compared using the concordance-index (C-index). Nomograms for OS, DSS and DFS were constructed based on both-directional stepwise Cox proportional hazards regression analysis and evaluated by the receiver operating characteristic (ROC) curve, the C-index and calibration plot. Results: In whole cohort, 86 patients (24.02%) were classified into low AFR group and had worse OS (hazard ratio [HR]: 4.079, 95% confidence interval [CI]: 2.085-7.982, P < 0.001), DSS (HR: 3.012, 95% CI: 1.302-6.966, P = 0.010) and DFS (HR: 1.863, 95% CI: 1.204-2.883, P = 0.005) compared to BC patients in high AFR group. Meanwhile, the AFR processed better prognostic power than albumin and fibrinogen, individually. Multivariate Cox analysis indicated that AFR was an independent prognostic factor for OS (HR: 2.601, 95% CI: 1.057-6.395, P = 0.037) and DFS (HR: 1.971, 95% CI: 1.049-3.703, P = 0.035). Novel nomograms, incorporating AFR, tumor grade and tumor multifocality, were constructed and successfully validated for predictions of OS, DSS and DFS in BC. Conclusions: Preoperative AFR was identified as an independent prognostic predictor for OS and DFS of BC patients underwent surgery. The nomograms incorporating AFR provided accurate predictions for OS, DSS and DFS, which could help urologists in better clinical decision-making.

Li S ，Zhang D ，Zeng S ，Wu T ，Wang Y ，Zhang H ，Wang B ，Hu X ... -  《-》

Serum uric acid to lymphocyte ratio: A novel prognostic biomarker for surgically resected early-stage lung cancer. A propensity score matching analysis.

This study aims to evaluate the prognostic impact of serum uric acid to lymphocyte ratio (ULR) in video-assisted thoracoscopic surgery (VATS) lobectomy for early-stage non-small-cell lung cancer (NSCLC) through a propensity score-matching (PSM) analysis. This study was carried out based on a prospectively-maintained database in our institution between January 2014 and July 2015. Survival analysis using a log-rank test was performed to distinguish the differences in both overall survival (OS) and disease-free survival (DFS) between the patients stratified according to an optimal cut-point of ULR. Finally, multivariable Cox proportional hazards regression analysis and PSM analysis were conducted to identify the prognostic factors of NSCLC. There were 335 patients with surgically resected primary stage I-II NSCLC included. An ULR at 3.83 was found to be the optimal cut-point regarding postoperative survival. Both OS and DFS of the patients with ULR > 3.83 were significantly shortened compared to those of the patient with ULR ≤ 3.83. Patients with ULR > 3.83 had significantly lower rates of OS and DFS until the last follow-up date than those of patients with ULR ≤ 3.83. These differences still remained significant after PSM analysis. Multivariate analyses for the entire cohort finally demonstrated that an elevated ULR could independently predict both unfavorable OS and DFS of surgically resected stage I-II NSCLC. ULR can be considered as a novel risk stratification tool to refine prognostic prediction for operable early-stage NSCLC.

Yang Z ，Li S ，Zhao L ，Lv W ，Ju J ，Zhang W ，Li J ，Che G ... -  《-》