| Background and Purpose:Lung cancer is the leading cause of cancer-related death worldwide,among which small cell lung cancer(SCLC)is a highly aggressive neuroendocrine tumor that often has regional lymph node or distant organ metastases at diagnosis,the clinical prognosis is poor.At present,a variety of biomarkers that help predict the prognosis of SCLC have been widely studied.The albumin to fibrinogen ratio(AFR)is a biomarker for assessing nutrition,coagulation,and inflammation,and is associated with overall survival(OS)for a variety of malignancies,including breast cancer and non-small cell lung cancer(NSCLC).However,little research has been done to predict the prognosis of SCLC patients after treatment by AFR.The purpose of this study was to evaluate the value of AFR in predicting the survival of SCLC after treatment by retrospectively analyzing the difference of OS and survival rate of SCLC after treatment with different AFR.Methods:Patients with SCLC diagnosed and initially treated at Dalian Central Hospital between January 2016 and December 2019,who met the inclusion and exclusion criteria,were collected and divided into high and low groups according to the optimal cut-off of AFR.The data of sex,age,smoking history,distant metastasis,clinical stage,treatment,time of disease progression and survival time were collected.The 1-year,2-year and 3-year survival rates and median survival time(MOS)were compared between the two groups to evaluate the application value of AFR in predicting the survival time and survival rate of SCLC.Results:A total of 55 patients with SCLC were included in this study,including 39 men(70.9%)and 16 women(29.1%),with a mean age of 62.71±8.48 years.Among them,19cases(34.5%)were younger than 60 years old,36 cases(65.5%)were older than or equal to 60 years old,32 cases(58.2%)had smoking history and 23 cases(41.8%)had nonsmoking history,27 cases(49.1%)had distant metastasis,28 cases(50.9%)had no distant metastasis,23 cases(41.8%)were limited stage,32 cases(58.2%)were extensive stage,25 cases(45.5%)were treated with radiotherapy and 30 cases(54.5%)were not treated with radiotherapy,9 cases(16.4%)were operated and 46 cases(83.6%)were unoperated.The optimal cut-off of AFR before treatment was 10.55(p = 0.001),with 30 cases(54.5%)in low AFR group and 25 cases(45.5%)in high AFR group.AFR was balanced between the two groups in terms of sex,age,smoking,radiation therapy and surgery,there was no significant difference(χ2 = 2.644,0.603,0.720,0.875,1.064,P = 0.140,0.437,0.396,0.349,0.302,respectively).There was significant difference in AFR level among patients with distant metastasis(χ2 = 11.546,P = 0.001).The level of AFR was significantly different between patients with limited and extensive SCLC(χ2 = 17.160,P < 0.001).The 1-year,2-year and 3-year OS rates of the high AFR group and low AFR group were(68%,60.0%),(52%,23.3%),(48%,3.3%),respectively.There was no significant difference in 1-year OS rates between the two groups(χ2 = 0.377,P = 0.539),there were significant differences in 2-year and 3-year OS rates between the two groups(χ2 values were 4.843 and 15.073,P = 0.028 and < 0.001,respectively).The median survival time(MOS)of high AFR and low AFR respectively was 29 months(95%CI: 12.10-36.00months)and 15 months(95%CI: 10.98-19.02 months).There was significant difference in m OS between the two groups(χ2 = 10.441,P = 0.001).In predicting survival of SCLC patients after treatment,patients with high AFR survived longer.Distant metastasis(HR: 3.486,95%CI: 1.833-6.629,P < 0.001),extensive stage(HR:2.375,95%CI: 1.240-4.551,P=0.009),surgery(HR: 0.317,95%CI: 0.113-0.891,P=0.029),AFR(HR: 2.842,95%CI: 1.441-5.605,P=0.003)were significant factors affecting OS in SCLC patients.Distant metastasis(HR: 5.268,95%CI: 1.541-18.012,P=0.008)and AFR(HR: 2.465,95%CI: 1.146-5.303,P=0.021)were independent factors of OS in SCLC patients.Conclusion:AFR before treatment was an independent predictor of OS in SCLC patients after treatment.Patients with SCLC with low AFR have shorter survival times. |
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