Prognostic value of combined platelet, fibrinogen, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients with lung adenosquamous cancer

Abstract

The aim of the present study was to investigate the prognostic value of the combined platelet (PLT), fibrinogen (FBG), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) (CO-NPF) for postoperative outcomes in patients with lung adenosquamous cancer (ASC). Test results from patients who presented at The Cancer Institute and Hospital of Tianjin Medical University between January 2005 and December 2013 were retrospectively reviewed. CO-NPF was scored between 0 and 4 according to increased PLT, FBG, NLR and PLR prior to being split into two groups based on the presence (≥2) or absence (<2) of the combination of increased inflammatory indexes. In total, data from 134 patients with ASC were reviewed for the present study. Multivariate analysis identified that increased CO-NPF (P=0.001 and P<0.001, respectively), PLR (P=0.011 and P=0.001, respectively) and FBG (P=0.001 and P<0.001, respectively) were independently associated with shorter disease-free survival (DFS) and overall survival (OS). NLR (P=0.006) and PLT (P=0.001) were independent prognostic factors for OS. The area under the receiver operating characteristic curves of CO-NPF (area under the curve, 0.652, P=0.008, 95% confidence interval, 0.551-0.752) was increased compared with NLR, PLR, PLT and FBG individually, suggesting that CO-NPF has greater predictive value. CO-NPF was significantly and independently associated with shorter DFS and OS, and had greater predictive value compared with NLR, PLR, PLT and FBG in patients with ASC who underwent surgery.

Keywords: fibrinogen; lung adenosquamous cancer; neutrophil to lymphocyte ratio; platelet; platelet to lymphocyte ratio.

Figure 1.

Kaplan-Meier estimator curves of DFS for all patients with adenosquamous cancer. DFS rates according to (A) NLR, (B) PLR, (C) PLT, (D) FBG and (E) CO-NPF. DFS, disease-free survival; NLR, neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio; PLT, platelet; FBG, fibrinogen; CO-NPF, combination of NLR, PLR, FBG and PLT.

Figure 2.

Kaplan-Meier estimator curves of OS for all patients with adenosquamous cancer. OS rates according to (A) NLR, (B) PLR, (C) PLT, (D) FBG and (E) CO-NPF. OS, overall survival; NLR, neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio; PLT, platelet; FBG, fibrinogen; CO-NPF, combination of NLR, PLR, FBG and PLT.

Figure 3.

Kaplan-Meier estimator curves of DFS and OS rates of patients with stage I–II adenosquamous cancer according to CO-NPF. (A) DFS and (B) OS rates, according to CO-NPF of patients of TNM I–II stage. DFS, disease-free survival; OS, overall survival; CO-NPF, combination of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, fibrinogen and platelet; TNM, tumor-node-metastasis.

Figure 4.

Area under the curve of NLR, PLR, PLT, FBG and CO-NPF. Comparison of receiver operating characteristic curves based on NLR, PLR, PLT, FBG and CO-NPF in the 3-year overall survival rate. NLR, neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio; PLT, platelet; FBG, fibrinogen; CO-NPF, combination of NLR, PLR, FBG and PLT.