Abstract
Lung cancer is one of the leading causes of cancer-associated mortality. C-reactive protein (CRP), albumin (ALB), globulin (GLB), lactate dehydrogenase (LDH), neutrophil-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been identified as general parameters for systemic inflammatory response (SIR). Furthermore, these parameters are also associated with tumor development and metastasis. The present study aimed to investigate the predictive values of these SIR parameters in patients with resectable lung cancer. In total, 101 patients with resectable lung cancer were recruited in the present study. The patients were divided into two groups according to the median value of pre-treatment CRP, ALB, GLB, LDH, NLR or PLR values. The post-/pre-treatment ratios were defined as the ratio of pre-treatment blood parameter values and the corresponding values obtained following therapy. A ratio of ≤1.1 indicated that the values were not increased, while a ratio of >1.1 suggested that the values were increased following treatment. Patients with lower pre-treatment ALB levels had poorer overall survival (OS) rates, whereas GLB, LDH, CRP, NLR or PLR levels were not associated with outcomes. Whole course treatment (surgery combined with adjuvant chemotherapy) significantly increased the value of ALB, but decreased the value of NLR, whereas it had no effect on the values of LDH, CRP or PLR. Post-/pre-treatment LDH and PLR were associated with outcomes. Post-/pre-treatment ALB, GLB, CRP and NLR were not associated with outcomes. Multivariate analysis revealed that a low pre-treatment ALB level and increased post-/pre-treatment PLR were independent risk factors affecting OS. The receiver operating characteristic curve analysis demonstrated that an ALB value of 47.850 g/l was considered to be the optimal cut-off value for prognosis; the sensitivity was 28.8% and specificity was 95.9%. It was suggested that the pre-treatment ALB and post-/pre-treatment PLR may be potential prognostic factors in resectable lung cancer.
Highlights
An estimated 4,292,000 newly diagnosed cases of cancer and 2,814,000 cancer‐associated mortalities occurred in China in 2015, and lung cancer accounted for nearly 20% of those cases [1]
A previous study confirmed an association among smoking, Chronic obstructive pulmonary disease (COPD) and lung cancer [28]
As systemic inflammation is associated with cancer development, the prognostic significance of indicators that assess the state of Systemic inflammatory response (SIR) requires further investigation
Summary
An estimated 4,292,000 newly diagnosed cases of cancer and 2,814,000 cancer‐associated mortalities occurred in China in 2015, and lung cancer accounted for nearly 20% of those cases [1]. Systemic inflammatory response (SIR) is associated with survival in a variety of cancer types, including gastric, esophageal and lung cancer [6,7,8]. Albumin (ALB) and globulin (GLB) are ZHU et al: PROGNOSTIC EVALUATION OF PATIENTS WITH RESECTABLE LUNG CANCER USING SYSTEMIC two major serum proteins. It is well known that low ALB and high GLB levels are associated with malnutrition and chronic inflammation [13]. The platelet‐to‐lymphocyte ratio (PLR), the proportion of absolute platelets to the lymphocyte count in peripheral blood, has been proposed as a reliable prognostic indicator for lung cancer [17,18]. The present study evaluated whether these SIR‐associated indicators may provide beneficial prognostic information for patients with resectable lung cancer. The post/pre‐treatment ratios were defined as the ratio of pre‐treatment SIR‐related indicator values and the corresponding ones obtained following therapy
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