Fibrinogen remains the most significant prognostic inflammatory index amongst five markers in operable primary lung cancer

Abstract

Over the past decade, many studies have shown that cancer-related inflammation substantially contributes to the tumor initiation and progression, cancer metastases, cancer response to therapy, and is related to a poor prognosis in many tumors. The inflammatory response indices fibrinogen, C-reactive protein (CRP), platelets, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been shown to have a significant impact on the prognosis of various types of cancers. However, the role of preoperative assessment of inflammatory markers as prognostic indicators in lung cancer remain to be established. Hyperfibrinogenemia in particular has been recognised as an independent risk factor for the outcome of primary lung cancer. Patients with lung cancer have remarkably different survival outcomes, even among cases with similar stage and histologic classifications. Numerous promising biomarkers have been evaluated as potential prognosis predictors. The aim of this study was to evaluate the prognostic significance of plasma fibrinogen, CRP, platelets, NLR, and PLR in patients with resectable lung cancer.
We studied 360 patients who underwent resection for primary lung cancer between 2013 and 2017. Resection was defined as segmentectomy, lobectomy, bilobectomy or pneumonectomy and included systematic mediastinum lymph node dissection.
We showed that patients with NSCLC had significantly higher inflammatory indices values compared to patients with neuroendocrine tumours and the optimal cut-off level for fibrinogen, CRP, NLR and PLR were 4.0g/L, more than 10.0 mg/L, 2.0, and 120, respectively. There was no correlation between survival and platelets counts, however, logistics regression analysis showed significant correlations between survival and the other four indices. Multivariate Cox regression analysis confirmed fibrinogen of more than 4.0g/L to be significantly correlated to survival (hazard ratio = 0.561, 95%CI (0.351-0.896), p=0.016). We have therefore demonstrated that pre-operative elevated fibrinogen, CRP, NLR, and PLR may be associated with increased mortality with fibrinogen being the only independent prognostic inflammatory factor in patients undergoing surgery for primary lung cancer.