A Laboratory Prognostic Index Model for Patients with Advanced Non-Small Cell Lung Cancer

Abstract

PurposeWe aimed to establish a laboratory prognostic index (LPI) in advanced non-small cell lung cancer (NSCLC) patients based on hematologic and biochemical parameters and to analyze the predictive value of LPI on NSCLC survival.Patients and MethodsThe study retrospectively reviewed 462 patients with advanced NSCLC diagnosed between 2000 and 2010 in a single institution. We developed an LPI that included serum levels of white blood cells (WBC), lactate dehydrogenase (LDH), albumin, calcium, and alkaline phosphatase (ALP), based on the results of a Cox regression analysis. The patients were classified into 3 LPI groups as follows: LPI 0: normal; LPI 1: one abnormal laboratory finding; and LPI 2: at least 2 abnormal laboratory findings.ResultsThe median follow up period was 44 months; the median overall survival (OS) and median progression-free survival (PFS) were 11 and 6 months, respectively. A multivariate analysis revealed that the following could be used as independent prognostic factors: an Eastern Cooperative Oncology Group performance status score (ECOG PS) ≥2, a high LDH level, serum albumin <3 g/dL, serum calcium>10.5 g/dL, number of metastases>2, presence of liver metastases, malignant pleural effusion, or receiving chemotherapy ≥4 cycles. The 1-year OS rates according to LPI 0, LPI 1, and LPI 2 were 54%, 34%, and 17% (p<0.001), respectively and 6-month PFS rates were 44%, 27%, and 15% (p<0.001), respectively. The LPI was a significant predictor for OS (Hazard Ratio (HR): 1.41; 1.05–1.88, p<0.001) and PFS (HR: 1.48; 1.14–1.93, p<0.001).ConclusionAn LPI is an inexpensive, easily accessible and independent prognostic index for advanced NSCLC and may be helpful in making individualized treatment plans and predicting survival rates when combined with clinical parameters.

Low level of 5-Hydroxymethylcytosine predicts poor prognosis in non-small cell lung cancer

“…Consitent with other reports (22), in the present study, low levels of 5-hmC were more common in patients with lymph node metastases, high histological types and large tumor sizes, which are recognized prognostic factors for lung cancer (23). The proportion of low 5-hmC level in NSCLC patients with lymph node metastases was markedly higher than those patients without lymph node metastases, as well as the histological types and tumor sizes.…”

Systemic Immune-inflammation Index, Based on Platelet Counts and Neutrophil-Lymphocyte Ratio, Is Useful for Predicting Prognosis in Small Cell Lung Cancer

“…LDH can be released during tissue damage and is involved in tumor initiation and metabolism. Numerous studies have shown that LDH activity is an indicator of metastatic risk and could be an important prognostic factor in a variety of cancers (Weide et al 2013;Cetin et al 2014;Philipp et al 2014;Ulas et al 2014;Liu et al 2015). The use of LDH as a prognostic factor in SCLC has also been demonstrated over recent decades (Tas et al 2001;Bremnes et al 2003;Hermes et al 2010).…”

Pretreatment Serum Albumin Level is an Independent Prognostic Factor in Patients with Stage IIIB Non-Small Cell Lung Cancer: A Study of the Turkish Descriptive Oncological Researches Group

“…The authors suggested that albumin and LDH levels might be used in the risk scoring in further studies. Further studies demonstrated that serum albumin level was a critical prognostic factor in the lung cancer (Forrest et al, 2003;Kasymjanova et al, 2010;Leung et al, 2012;Trape et al, 2012;Gagnon et al, 2013;Jafri et al, 2013;Ulas et al, 2014). In these studies, prognostic risk models were created using a number of clinical and laboratory variables and low serum albumin level was found to be one of the poor prognostic factors in the majority of the scoring systems.…”

“…With the introduction of recent findings, the Glasgow Prognostic Score (GPS) and the Advanced Lung Cancer Inflammation Index (ALI) on the basis of serum albumin and CRP level have been developed. In addition, further scoring systems such as modified-GPS, Prognostic Index (PI), Adverse Prognostic Factors (APF), and the Montreal Prognostic Score (MPS) based on the performance status, CRP, tumor markers such as carbohydrate antigen (CA)-125, and inflammatory markers such as leukocycte and neutrophil/lymphocyte ratio have been developed (Forrest et al, 2003;Kasymjanova et al, 2010;Leung et al, 2012;Trape et al, 2012;Gagnon et al, 2013;Jafri et al, 2013;Ulas et al, 2014). In the majority of these studies, many patients had a metastatic disease (Forrest et al, 2003;Kasymjanova et al, 2010;Leung et al, 2012;Trape et al, 2012;Gagnon et al, 2013;Jafri et al, 2013;Ulas et al, 2014).…”

“…These findings suggested that performance status, female sex, bone, liver, and subcutaneous metastasis, the absence of symptom and weight loss, and non-large cell histology had a positive impact on survival (Finkelstein et al, 1986). In addition, further studies showed that age, cisplatin-based regimens, Karnofsky performance score, leukocytosis, hypercalcemia, neutrophilia, male sex, skin and liver metastasis, and weight loss were among the poor prognostic factors (Albain et al, 1991;Paesmans et al, 1995;Ulas et al, 2014).…”