Plasma Fibrinogen And Serum Albumin Levels(FA Score) Act As A Promising Prognostic Indicator In Non-small Cell Lung Cancer

Backgrounds and objective:According to the global cancer statistics,lung cancer ranked as the leading cause of cancer death among males in 2012.The 5-year survival rate of lung cancer patients remains only about 17.4%although various therapies are adopted.It is necessary to develop effective biomarkers to identify patients who may have poor clinical outcomes after surgical treatment.Evidence implies that preoperative plasma fibrinogen and serum albumin are associated with cancer prognosis.Studies confirmed the relationship between high serum fibrinogen levels and poor prognosis in non-small cell lung cancer(NSCLC)patients,and albumin also has a strong association with outcomes of NSCLC patients.The combination of fibrinogen and albumin may serve as an effective scoring system to predict prognosis of NSCLC patients.High preoperative prognostic nutritional index(PNI)is related to small tumor size,well differential grade,pathological stage I,and long survival time in NSCLC patients.In this study,we aimed to explore the prognostic values of the score based on plasma fibrinogen and serum albumin levels(FA score)in NSCLC,and to compare that with PNI.Methods:In all,182 patients with pathologically diagnosed NSCLC who underwent pneumonectomy at Qilu Hospital of Shandong University between January 2009 and December 2010 were recruited into our study.Patients were followed up every 3-4 months in the first 2 years after surgery and every 6 months thereafter until they were lost or dead.From receiver operating characteristic(ROC)curve analysis,cutoff values of fibrinogen and albumin were determined.An unpaired t-test and one-way analysis of variance were adopted to analyze continuous variables of different subgroups.Relationships between categorical variables were assessed using Fisher’s exact test or Pearson’s chi-square test.In the analyses of PFS and OS,Kaplan—Meier method and log-rank tests were used.The Cox proportional hazards regression model was adopted in the univariate and multivariate analyses.A two-sided p value was used in this study and<0.05 was considered statistically significant.Results:High FA score was related to smoking(p=0.005),poor differential grade(p=0.002),and advanced T stage(p<0.001)and TNM stage(p=0.011).Low PNI showed association with advanced T stage(p=0.030).Kaplan-Meier survival analysis indicated that high FA score and low PNI were associated with poor progression-free survival(PFS;for the FA score,p<0.001;for PNI,p=0.001)and overall survival(OS;for the FA score,p<0.001;for PNI,p=0.013),respectively.Multivariate analysis revealed that FA score was an independent predictor for PFS(p=0.003)and OS(p=0.001)in NSCLC patients.In the survival analysis of squamous cell carcinoma(SCC)patients,high FA score and low PNI were both associated with shorter survival time(all p<0.05).But for adenocarcimoma(ADC)patients,PNI showed no statistical relationship with PFS(p=0.062)and OS(p=0.466).Moreover,FA score was associated statistically with the 1-year(p=0.047),3-year(p=0.001),and 5-year(p<0.001)OS,while PNI showed no predictive value for 1-year OS(p=0.069).Conclusion:The FA score showed an effective power in predicting NSCLC patients’prognosis and acted as an independent survival predictive factor for PFS and OS.The FA score could act as a more promising prognostic predictor than PNI in NSCLC patients who underwent pneumonectomy.Applied into clinical practice,it can facilitate doctors’ selection of patients who are at high risk and may need to accept more adjuvant therapies and more frequent follow-up,which are beneficial for personalized treatment in NSCLC patients.