Prognostic Significance Of Fibrinogen And Neutrophil-lymphocyte Ratio In Advanced Non-small Cell Lung Cancer

PurposeAdvanced non-small cell lung cancer(NSCLC)progresses rapidly,with easy metastasis and recurrence,low 5-year survival rate and poor prognosis.Systemic inflammatory system and coagulation system are involved in the occurrence,development,metastasis and recurrence of malignant tumors.Among a number of prognostic indicators that affect tumors,F-NLR scores based on plasma fibrinogen(Fbg)and neutrophil-to-lymphocyte ration(NLR)have been proved to be closely correlated with the prognosis of patients with many malignant tumors,but the correlation with advanced non-small cell lung cancer remains unclear.This study is the first to explore the clinical adaptability of F-NLR score,to predict the efficacy of chemotherapy in patients with advanced NSCLC,and to determine the prognostic effect of patients.MethodA retrospective analysis was performed on 156 patients with advanced non-small cell lung cancer who underwent first-line chemotherapy in the Affiliated Hospital of Qingdao University from January 1,2012 to December 31,2014.The fibrinogen concentration and neutrophil-to-lymphocyte ration were collected one week before the initial diagnosis.Some clinical pathological data,such as gender,age,smoking history,tumor size,tumor location(left/right lung)and TNM stage,clinical stage,histological type,lymph node metastasis and distant metastasis,as well as progression-free survival(PFS)and overall survival(OS)were collected.The therapeutic effect of solid tumors was evaluated with the response evaluation criteria in solid tumors(RECIST)1.1.All patients were evaluated every 2 cycles during chemotherapy,and after 6 cycles were divided into two groups(PD group and non-PD group)according to tumor response.All statistical analyses were performed by SPSS22.0 statistical software.The critical values of plasma fibrinogen level and NLR were determined by using the receiver operating characteristic ROC curve and the area under curve(AUC).Wilcoxon rank sum test was used to evaluate the relationship between the response of tumors to treatment and the scores of fibrinogen,NLR andF-NLR.? 2 test was used to evaluate the difference between F-NLR and each classification variable.The survival curve was constructed by Kaplan-Meier method.Prognostic factors was used to evaluate by single factor and multi-factor analysis in Cox proportional hazard regression model.P<0.05 was considered statistically significant.ResultAccording to the receiver operating characteristic ROC curve and the area under curve(AUC),the critical value of plasma fibrinogen concentration and NLR was 402.5g/L and2.44,respectively.The F-NLR scores of all patients were divided into three groups: 2points(plasma fibrinogen concentration > 402.5g/L and NLR > 2.44),1 point(plasma fibrinogen concentration > 402.5g/L or NLR > 2.44),0 point(plasma fibrinogen concentration< 402.5g/L and NLR < 2.44).The levels of F-NLR in patients with advanced NSCLC before treatment were closely correlated with gender(P=0.015),differentiation degree(P=0.037),T stage(P=0.018),TNM stage(P=0.025),smoking history(P=0.012).According to the tumor response grouping,the disease progression group(PD group)had 32 patients and the non-disease progression group(non-PD group)had 124 patients.The average fibrinogen level and NLR ratio in PD group were significantly higher than those in non-PD group(P=0.007,P=0.011).F-NLR score of PD group was significantly higher than that of non-PD group(P=0.012).Single factor analysis results showed that smoking history(P=0.000),T stage(P=0.008),degree of tumor differentiation(P=0.022),plasma fibrinogen level(P=0.000),NLR level(P=0.001),F-NLR score(P=0.000)were the factors influencing the prognosis of patients.Multi-factor analysis results showed that smoking history(P=0.000),tumor stage(P=0.000),T stage(P=0.017)and F-NLR score(P=0.000)were independent factors influencing the prognosis of patients.Risk factors,the median progression-free survival time and median survival time of patients with F-NLR 2 points were significantly lower than those of patients with F-NLR 0 and 1 point(P=0.000,P=0.000).The higher the F-NLR score was,the worse the prognosis of patients was.ConclusionThe increase of F-NLR level in patients with advanced NSCLC before treatment is correlated with the progression of tumor,suggesting that the prognosis of patients is poor.A new scoring system based on F-NLR suggests that it can be used as a new indicator to predict the progression and prognosis of patients with advanced NSCLC.