Prognostic Value Of Dynamic Albumin-to-alkaline Phosphatase Ratio In Limited Stage Small-cell Lung Cancer

ObjectivesSmall cell lung cancer(SCLC)is characterized by high invasiveness,rapid metastasis and poor prognosis.For patients with local limited stage SCLC(LS-SCLC),platinum-etoposide combined with chest radiotherapy is still the standard treatment pattern.The prognostic effect of albumin-to-alkaline phosphatase ratio(AAPR)has been confirmed in nasopharyngeal cancer and liver cancer,etc.This study aims to a dynamically investigate the prognostic value of AAPR in LS-SCLC.Materials&methodsThis study retrospectively analyzed 122 patients who were initially diagnosed as LS-SCLC in Shandong Cancer Hospital between January 2013 and March 2015 and received first-line platinum plus etoposide combined with local radiotherapy.We collected patients'age,gender,smoking history,KPS score and other basic characteristics,TNM staging and other oncology characteristics,hematological indicators such as ALB,ALP and AAPR in peripheral blood before and after treatment,and prognostic indicators such as PFS and OS were also collected.The correlation between clinical characteristics and pre-AAPR and post-AAPR was analyzed by?~2test.Univariate and multivariate Cox regression analysis was used to determine independent factors affecting the prognosis of LS-SCLC,and AAPR and TNM staging were integrated to evaluate their prognostic ability.ResultsA total of 122 eligible patients with LS-SCLC were included in this study.The median OS was 21.3 months,the median PFS was 10.9 months,and the disease control rate was86.9%.The correlation analysis of?~2test showed that there was no significant correlation between AAPR and age,gender,smoking history,KPS score,N stage,sequential or concurrent chemoradiotherapy,CRT or IMRT.Univariate analysis of OS showed that low pre-AAPR and post-AAPR were associated with poor OS in male patients with smoking history and poor KPS score.Further multivariate analysis showed that only post-AAPR(HR=0.50,95%CI 0.31-0.79,p=0.003)was an independent factor leading to poor OS prognosis.Univariate analysis of PFS showed that N2-N3 tumor stage,high post-ALP,low pre-AAPR and post-AAPR were associated with poor PFS.Further multivariate analysis showed that tumor N stages(HR=2.08,95%CI:1.01-4.32,p=0.049)and post-AAPR(HR=0.55,95%CI:0.35-0.85,p=0.007)were independent factors leading to poor prognosis of PFS.In addition,the predictive power of pre-AAPR and post-AAPR was better than the traditional TNM staging(0.63 vs 0.55 and 0.66 vs 0.55).The integration of pre-or post-AAPR improved the prognostic ability of tumor node metastasis stage alone(0.55–0.64 and 0.68,respectively).ConclusionPost-AAPR is a reliable prognostic factor for LS-SCLC patients.The complementary value of AAPR to tumor node metastasis stage is worth further validation in the future.