Prognostic significance of platelet and albumin/fibrinogen ratio in second-line therapy of bevacizumab for advanced non-small cell lung cancer

doi:10.3877/cma.j.issn.1674-6902.2024.01.007

Abstract

Abstract:

Objective

To study the effects of platelet (PLT), fibrinogen (FIB) and albumin / fibrinogen (ALB/FIB) on the prognosis of patients with advanced non-small cell lung cancer (NSCLC) who received second-line therapy with bevacizumab.

Methods

The baseline clinical characteristics and blood parameters of 91 patients with advanced NSCLC treated with bevacizumab in Qingdao Municipal Hospital were retrospectively analyzed. PLT, FIB and ALB/FIB are based on the latest blood test results before bevacizumab treatment to determine their best cut-off values. Kaplan-Meier analysis and COX regression analysis were used to analyze the factors related to progression-free survival (PFS).

Results

Univariate analysis indicates a significant correlation between baseline PLT, FIB, ALB/FIB, and progression-free survival (PFS). Multivariate analysis reveals that baseline PLT and FIB are not independent prognostic factors for PFS. Instead, age (HR: 1.719, 95%CI: 1.036-2.851, P=0.036), brain metastasis (HR: 0.475, 95%CI: 0.269-0.840, P=0.01), and prior surgery (HR: 0.479, 95%CI: 0.251-0.913, P=0.025) emerge as independent prognostic factors for PFS. Additionally, the analysis indicates that a high pre-treatment level of ALB/FIB ratio independently predicts longer PFS (HR: 0.118, 95%CI: 0.025-0.553, P=0.007). Utilizing X-tile software, the optimal cutoff values for baseline PLT, FIB, and ALB/FIB are determined to be 282, 4.61, and 8.8, respectively. Kaplan-Meier analysis reveals that patients in the baseline low platelet (PLT) group exhibit a more favorable prognosis compared to those in the baseline high PLT group (217 d vs. 386 d, P<0.001). Similarly, patients in the baseline low fibrinogen (FIB) group demonstrate a superior prognosis compared to the baseline high FIB group (200 d vs. 337 d, P<0.001). Furthermore, patients in the baseline high albumin/fibrinogen (ALB/FIB) group exhibit a more favorable prognosis compared to the baseline low ALB/FIB group (360 d vs. 183 d, P<0.001).

Conclusion

Low levels of baseline PLT, FIB and high levels of baseline ALB/FIB may indicate a better prognosis in patients with advanced non-small cell lung cancer treated with bevacizumab.

Key words: Non-small cell lung cancer, Bevacizumab, Platelet, Albumin/fibrinogen ratio, Prognostic factors

Zhen Wang, Lu Huang, Lianqun Lang, Lu Yue. Prognostic significance of platelet and albumin/fibrinogen ratio in second-line therapy of bevacizumab for advanced non-small cell lung cancer[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(01): 35-40.

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References 36

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临床资料	变　量	例数	风险比(95%可信区间)	P值
性别	男	55	1.253(0.819～1.918)	0.299
	女	36
年龄(岁)	<65	53	1.166(0.906～2.390)	0.481
	≥65	38
吸烟史	是	31	1.001(0.644～1.555)	0.998
	否	60
脑转移	是	26	0.543(0.315～0.937)	0.028^a
	否	65
胸膜转移	是	38	0.542(0.336～0.875)	0.012^a
	否	65
二线治疗方案	联合化疗	46	1.432(0.937～2.188)	0.097
	联合EGFR抑制剂	28	0.844(0.557～1.278)	0.422
	联合化疗和免疫	17	0.853(0.548～1.342)	0.501
既往手术	是	25	0.571(1.083～3.170)	0.024^a
	否	66
既往局部放疗	是	41	0.789(0.351～0.930)	0.270
	否	50
PLT	<282	66	2.552(1.557～4.184)	0.000^a
	≥282	25
FIB	<4.61	66	2.626(1.606～4.294)	0.000^a
	≥4.61	25
ALB/FIB(AFR)	<8.84	25	0.331(0.204～0.537)	0.000^a
	≥8.84	66

临床资料	变　量	例数	风险比(95%可信区间)	P值
性别	男	55	1.253(0.819～1.918)	0.299
	女	36
年龄(岁)	<65	53	1.166(0.906～2.390)	0.481
	≥65	38
吸烟史	是	31	1.001(0.644～1.555)	0.998
	否	60
脑转移	是	26	0.543(0.315～0.937)	0.028^a
	否	65
胸膜转移	是	38	0.542(0.336～0.875)	0.012^a
	否	65
二线治疗方案	联合化疗	46	1.432(0.937～2.188)	0.097
	联合EGFR抑制剂	28	0.844(0.557～1.278)	0.422
	联合化疗和免疫	17	0.853(0.548～1.342)	0.501
既往手术	是	25	0.571(1.083～3.170)	0.024^a
	否	66
既往局部放疗	是	41	0.789(0.351～0.930)	0.270
	否	50
PLT	<282	66	2.552(1.557～4.184)	0.000^a
	≥282	25
FIB	<4.61	66	2.626(1.606～4.294)	0.000^a
	≥4.61	25
ALB/FIB(AFR)	<8.84	25	0.331(0.204～0.537)	0.000^a
	≥8.84	66

变　量	风险比(95%可信区间)	P值
性别	1.171(0.649～2.115)	0.599
年龄	1.719(1.036～2.851)	0.036^a
吸烟史	0.714(0.404～1.263)	0.247
脑转移	0.475(0.269～0.840)	0.010^a
胸膜转移	1.165(0.675～2.012)	0.582
手术	0.479(0.251～0.913)	0.025^a
PLT	1.749(0.925～3.307)	0.085
FIB	0.298(0.059～1.500)	0.142
ALB/FIB	0.118(0.025～0.553)	0.007^a

变　量	风险比(95%可信区间)	P值
性别	1.171(0.649～2.115)	0.599
年龄	1.719(1.036～2.851)	0.036^a
吸烟史	0.714(0.404～1.263)	0.247
脑转移	0.475(0.269～0.840)	0.010^a
胸膜转移	1.165(0.675～2.012)	0.582
手术	0.479(0.251～0.913)	0.025^a
PLT	1.749(0.925～3.307)	0.085
FIB	0.298(0.059～1.500)	0.142
ALB/FIB	0.118(0.025～0.553)	0.007^a

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