Prognostic value of albumin-to-fibrinogen ratio combined with body mass index in patients with positive minimal residual disease following surgery for non-small cell lung cancer
LI Yuzheng
ZHOU Hua
WU Qibiao
LIU Hongyu
Abstract：Objective To investigate the predictive value of the albumin-to-fibrinogen ratio(AFR)combined with baseline body mass index(BMI)for the prognosis of non-small cell lung cancer(NSCLC)patients with minimal residual disease(MRD)positivity after surgery.Methods Between May 2015 and July 2019,a total of 305 NSCLC patients admitted to Puning People's Hospital were enrolled in this study,all of whom were confirmed to be in a state of MRD positivity through circulating tumor DNA(ctDNA)testing after surgery.Based on the 5-year follow-up survival outcomes,the cohort was divided into a survival group and a death group for comparison.Basic patient data were collected,including gender,age,smoking history,maximum tumor diameter,disease duration,lateral position,T stage,lymph node metastasis,anatomic location,history of adjuvant therapy(chemotherapy and radiotherapy),and underlying diseases(hypertension,diabetes,etc.).Preoperative baseline BMI and key biochemical indicators were also recorded,specifically white blood cells,red blood cells,hemoglobin,platelets,D-dimer,albumin(ALB)and fibrinogen(FIB)levels.AFR was derived from the ratio of ALB to FIB.Logistic regression analysis was used to identify prognostic factors,and receiver operating characteristic curves were plotted to evaluate predictive efficacy.The Kaplan-Meier method was applied to generate survival curves for survival analysis.Results Based on 5-year survival status,305 postoperative NSCLC patients were categorized into a survival group(n=52)and a death group(n=253).No statistically significant differences were observed between the two groups in terms of gender,age,smoking history,maximum tumor diameter,disease duration,lesion location,T stage,lymph node metastasis,tumor location,adjuvant chemotherapy,adjuvant radiotherapy,or underlying diseases such as hypertension,diabetes,and gout(P>0.05).The death group showed significantly lower levels of ALB[(30.12±0.95)g/L vs.(34.09±1.45)g/L],AFR[(7.54±0.56)vs.(8.66±0.50)],and baseline BMI[(21.95±1.31)kg/m2 vs.(25.08±1.54)kg/m2]compared to the survival group(P<0.001).In contrast,the death group had a higher FIB level[(3.98±0.12)g/L vs.(3.92±0.13)g/L,P=0.001].Multivariate logistic regression analysis identified both AFR and baseline BMI as independent prognostic factors for 5-year survival(P<0.05).The area under the curve for predicting 5-year survival using AFR,BMI,and their combination all exceeded 0.933,with sensitivity≥96.15%and specificity≥69.17%.Furthermore,patients with AFR≥8.095 or BMI≥22.62 kg/m2 had significantly higher 5-year overall survival rates(P<0.001).Conclusion AFR and baseline BMI are independent predictors of postoperative survival in NSCLC patients with positive ctDNA MRD,and their combined model demonstrates excellent predictive performance,supporting its use in individualized prognostic evaluation.
Keywords：Non-small cell lung cancerAlbumin-to-fibrinogen ratioBody mass indexCirculating tumor DNAMinimal residual diseasePrognosis
Publication Date：2025-07-28
Online Publishing Date：2025-10-17(First online date of this platform, not the publication date of the document)
Pages：6( 691-696 )