Prognostic Significance Of Preoperative Coagulation Assays And Neutrophil-Lymphocyte Ratio In Patients With Non-Small Cell Lung Cancer After Complete Resection

Objective 1?To evaluate the correlation between preoperative coagulation assays' levels and overall survival(OS) in patients with non-small cell lung cancer(NSCLC) after complete resection.2?The aim of this study was to evaluate the clinical significance of the preoperative neutrophil-lymphocyte ratio(NLR) in patients who underwent complete resection for non-small cell lung cancer(NSCLC).Methods A retrospective study of 754 patients with NSCLC undergoing complete resection was conducted about preoperative coagulation at the Tianjin Medical University Cancer Institute and Hospital from January 2004 to December 2008. And a total of 681 patients, who underwent complete resection for NSCLC were included in this study of NLR. The correlation of preoperative coagulation assays' levels and NLR with other variables was evaluated by Kruskall-Wallis and Mann-Whitney U test. Univariate and multivariate analysis was employed to determine the association between the preoperative level of coagulation factors and OS.Results 1 ? All preoperative coagulation tests' levels(prothrombintime(PT); International Normalized Ratio(INR); activated partial thromboplastin time(APTT); thrombin time(TT); fibrinogen(Fbg); D-dimer)were associated with T stage and clinical stage. Univariate analysis of survival showed that preoperative prolonged prothrombintime(PT)(?~2=8.254, P=0.004) and International Normalized Ratio(INR)(?~2=5.404, P=0.020), and abnormally elevated fibrinogen(Fbg)(?~2=9.184, P=0.002) and D-dimer(?~2=9.184, P=0.002) were associated with a poor prognosis. And the multivariate model confirmed preoperative D-dimer was an independent prognostic factor for the patients with NSCLC(P=0.019).2?Based on the cut off value of 2.3, 269 patients had NLR greater than 2.3 and 412 patients had NLR equal to or less than 2.3. Overall survival(OS) of patients with a high NLR was significantly worse than that of patients with a low NLR(34.1% VS 56.1%, P<0.001). Univariate analysis demonstrated that surgical procedure(P=0.044), lesion(P=0.034), pathological stage(P<0.001), chemotherapy(P=0.007), monocytes(P=0.003), Lactate dehydrogenase(P<0.001), fibrinogen(P=0.001), and D-dimer(P=0.012) were significantly associated with 5-year OS rate. Multivariate analysis showed that a high preoperative NLR was an independent risk factor for reduced survival(P<0.001; adjusted hazard ratio, 1.640; 95% confidence interval, 1.319-2.038).Conclusions 1?Preoperative prolongation of PT and INR, and elevation of Fbg and D-dimer are associated with decreased survival in NSCLC patients, and preoperative plasma D-dimer level is an independent prognostic factor of survival in patients with NSCLC after complete resection. 2?Preoperative NLR may be useful as a clinical biological marker to predict prognosis in patients undergoing complete resection for NSCLC.