Research Article

Prognostic value of dynamic albumin-to-alkaline phosphatase ratio in limited stage small-cell lung cancer

School of Medicine & Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, PR China

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, PR China

^‡Authors contributed equally

Search for more papers by this author

Butuo Li^‡

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, PR China

Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention & Therapy, Tianjin, PR China

^‡Authors contributed equally

Search for more papers by this author

Haiyan Zeng

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, PR China

Search for more papers by this author

Shijiang Wang

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, PR China

Search for more papers by this author

Xindong Sun

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, PR China

Search for more papers by this author

Yishan Yu

**Author for correspondence:

E-mail Address: eashion_yu@126.com

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, PR China

School of Medicine, Shandong University, Jinan, Shandong, PR China

Search for more papers by this author

Linlin Wang

*Author for correspondence:

E-mail Address: wanglinlinatjn@163.com

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, PR China

Search for more papers by this author

Jinming Yu

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, PR China

Search for more papers by this author

Published Online:15 Jan 2019https://doi.org/10.2217/fon-2018-0818

View article

Abstract

Aim: To dynamically investigate the prognostic value of albumin-to-alkaline phosphatase ratio (AAPR) in limited stage small-cell lung cancer. Materials & methods: The AAPR within 1 week before and after chemoradiation therapy (pre- and post-AAPR) was collected and analyzed. Results: Patients with low pre- or post-AAPR had shorter overall survival and progression-free survival than the high groups (p-values all <0.05). Post-AAPR was an independent prognostic factor for progression-free survival (p = 0.007) and overall survival (p = 0.003). 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). Conclusion: Post-AAPR is a reliable prognostic factor for limited stage small-cell lung cancer patients. The complementary value of AAPR to Tumor, Node, Metastasis stage is worth further validation in the future.

Keywords:

Papers of special note have been highlighted as: • of interest

References

1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J. Clin. 68(1), 7–30 (2018).Crossref, Medline, Google Scholar
2 Van Meerbeeck JP, Fennell DA, De Ruysscher DK. Small-cell lung cancer. Lancet 378(9804), 1741–1755 (2011).Crossref, Medline, Google Scholar
3 National Cancer Institute. SEER program. https://seer.cancer.gov/csr/1975_2015/browse_csr.php.Google Scholar
4 Sculier JP, Chansky K, Crowley JJ et al. The impact of additional prognostic factors on survival and their relationship with the anatomical extent of disease expressed by the 6th Edition of the TNM Classification of Malignant Tumors and the proposals for the 7th Edition. J. Thorac. Oncol. 3(5), 457–466 (2008).Crossref, Medline, Google Scholar
5 Li J, Dai CH, Chen P et al. Survival and prognostic factors in small cell lung cancer. Med. Oncol. 27(1), 73–81 (2010).Crossref, Medline, CAS, Google Scholar
6 Shepherd FA, Crowley J, Van Houtte P et al. The International Association for the Study of Lung Cancer lung cancer staging project: proposals regarding the clinical staging of small cell lung cancer in the forthcoming (seventh) edition of the Tumor, Node, Metastasis classification for lung cancer. J. Thorac. Oncol. 2(12), 1067–1077 (2007).Crossref, Medline, Google Scholar
7 Paesmans M, Sculier JP, Lecomte J et al. Prognostic factors for patients with small cell lung carcinoma: analysis of a series of 763 patients included in 4 consecutive prospective trials with a minimum follow-up of 5 years. Cancer 89(3), 523–533 (2000).Crossref, Medline, CAS, Google Scholar
8 Butof R, Gumina C, Valentini C et al. Sites of recurrent disease and prognostic factors in SCLC patients treated with radiochemotherapy. Clin. Transl. Radiat. Oncol. 7, 36–42 (2017).Crossref, Medline, Google Scholar
9 Wen Q, Meng X, Xie P, Wang S, Sun X, Yu J. Evaluation of factors associated with platinum-sensitivity status and survival in limited-stage small cell lung cancer patients treated with chemoradiotherapy. Oncotarget 8(46), 81405–81418 (2017).Crossref, Medline, Google Scholar
10 Suzuki R, Lin SH, Wei X et al. Prognostic significance of pretreatment total lymphocyte count and neutrophil-to-lymphocyte ratio in extensive-stage small-cell lung cancer. Radiother. Oncol. 126(3), 499–505 (2018).Crossref, Medline, Google Scholar
11 Heys SD, Walker LG, Deehan DJ, Eremin OE. Serum albumin: a prognostic indicator in patients with colorectal cancer. J. R. Coll. Surg. Edinb. 43(3), 163–168 (1998).Medline, CAS, Google Scholar
12 Lien YC, Hsieh CC, Wu YC et al. Preoperative serum albumin level is a prognostic indicator for adenocarcinoma of the gastric cardia. J. Gastrointest. Surg. 8(8), 1041–1048 (2004).Crossref, Medline, Google Scholar
13 Ouyang X, Dang Y, Zhang F, Huang Q. Low serum albumin correlates with poor survival in gastric cancer patients. Clin. Lab. 64(3), 239–245 (2018).Medline, CAS, Google Scholar
14 Takeda K, Umezawa R, Takahashi N et al. Impact of change in serum albumin level during and after chemoradiotherapy in patients with locally advanced esophageal cancer. Esophagus 15(3), 190–197 (2018).Crossref, Medline, Google Scholar
15 Wang X, Han H, Duan Q, Khan U, Hu Y, Yao X. Changes of serum albumin level and systemic inflammatory response in inoperable non-small cell lung cancer patients after chemotherapy. J. Cancer Res. Ther. 10(4), 1019–1023 (2014). • The level of serum albumin is a good prognostic factor in various malignancies, including lung cancer.Crossref, Medline, Google Scholar
16 Liu X, Meng QH, Ye Y, Hildebrandt MA, Gu J, Wu X. Prognostic significance of pretreatment serum levels of albumin, LDH and total bilirubin in patients with non-metastatic breast cancer. Carcinogenesis 36(2), 243–248 (2015).Crossref, Medline, Google Scholar
17 Chi KN, Kheoh T, Ryan CJ et al. A prognostic index model for predicting overall survival in patients with metastatic castration-resistant prostate cancer treated with abiraterone acetate after docetaxel. Ann. Oncol. 27(3), 454–460 (2016).Crossref, Medline, CAS, Google Scholar
18 Jin Y, Yuan MQ, Chen JQ, Zhang YP. Serum alkaline phosphatase predicts survival outcomes in patients with skeletal metastatic nasopharyngeal carcinoma. Clinics (Sao Paulo) 70(4), 264–272 (2015).Crossref, Medline, Google Scholar
19 Kim JM, Kwon CH, Joh JW et al. The effect of alkaline phosphatase and intrahepatic metastases in large hepatocellular carcinoma. World J. Surg. Oncol. 11, 40 (2013). • A novel prognostic index (albumin-to-alkaline phosphatase ratio), calculated by albumin and alkaline phosphatase, has been demonstrated as a promising prognostic index in hepatocellular carcinoma.Crossref, Medline, Google Scholar
20 Cai X, Chen Z, Chen J et al. Albumin-to-alkaline phosphatase ratio as an independent prognostic factor for overall survival of advanced hepatocellular carcinoma patients without receiving standard anti-cancer therapies. J. Cancer. 9(1), 189–197 (2018).Crossref, Medline, Google Scholar
21 Chan AW, Chan SL, Mo FK et al. Albumin-to-alkaline phosphatase ratio: a novel prognostic index for hepatocellular carcinoma. Dis. Markers 2015, 564057 (2015).Crossref, Medline, Google Scholar
22 Kalemkerian GP, Gadgeel SM. Modern staging of small cell lung cancer. J. Natl Compr. Canc. Netw. 11(1), 99–104 (2013).Crossref, Medline, Google Scholar
23 Detterbeck FC, Chansky K, Groome P et al. The IASLC Lung Cancer Staging Project: methodology and validation used in the development of proposals for revision of the stage classification of NSCLC in the forthcoming (eighth) edition of the TNM classification of lung cancer. J. Thorac. Oncol. 11(9), 1433–1446 (2016).Crossref, Medline, Google Scholar
24 Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom. J. 47(4), 458–472 (2005).Crossref, Medline, Google Scholar
25 Li J, Cheng Y, Liu G, Ji Z. The association of pretreatment serum albumin with outcomes in bladder cancer: a meta-analysis. Onco. Targets Ther. 11, 3449–3459 (2018).Crossref, Medline, Google Scholar
26 Alwarawrah Y, Kiernan K, Maciver NJ. Changes in nutritional status impact immune cell metabolism and function. Front. Immunol. 9, 1055 (2018).Crossref, Medline, Google Scholar
27 Harris H. The human alkaline phosphatases: what we know and what we don't know. Clin. Chim. Acta 186(2), 133–150 (1990).Crossref, Medline, CAS, Google Scholar
28 Rader BA. Alkaline phosphatase, an unconventional immune protein. Front. Immunol. 8, 897 (2017).Crossref, Medline, Google Scholar
29 Rao SR, Snaith AE, Marino D et al. Tumour-derived alkaline phosphatase regulates tumour growth, epithelial plasticity and disease-free survival in metastatic prostate cancer. Br. J. Cancer 116(2), 227–236 (2017). • Tumor derived alkaline phosphatase could regulate tumor growth and may influence the tumor in a different way.Crossref, Medline, CAS, Google Scholar
30 Zhou T, Hong S, Hu Z et al. A systemic inflammation-based prognostic scores (mGPS) predicts overall survival of patients with small-cell lung cancer. Tumour Biol. 36(1), 337–343 (2015). • Recently, the combined biomarkers improved the prognostic power and could guide the clinical decision-making.Crossref, Medline, Google Scholar
31 Hong S, Zhou T, Fang W et al. The prognostic nutritional index (PNI) predicts overall survival of small-cell lung cancer patients. Tumour Biol. 36(5), 3389–3397 (2015).Crossref, Medline, CAS, Google Scholar
32 Zhou T, Zhan J, Hong S et al. Ratio of C-reactive protein/albumin is an inflammatory prognostic score for predicting overall survival of patients with small-cell lung cancer. Sci. Rep. 5, 10481 (2015).Crossref, Medline, Google Scholar
33 Zhou T, He X, Fang W et al. Pretreatment albumin/globulin ratio predicts the prognosis for small-cell lung cancer. Medicine (Baltimore) 95(12), e3097 (2016).Crossref, Medline, CAS, Google Scholar
34 Jin S, Cao S, Xu S, Wang C, Meng Q, Yu Y. Clinical impact of pretreatment prognostic nutritional index (PNI) in small cell lung cancer patients treated with platinum-based chemotherapy. Clin. Respir. J. 12(9), 2433–2440 (2018).Crossref, Medline, CAS, Google Scholar
35 Wang L, Dou X, Liu T, Lu W, Ma Y, Yang Y. Tumor size and lymph node metastasis are prognostic markers of small cell lung cancer in a Chinese population. Medicine 97(31), e11712 (2018).Crossref, Medline, Google Scholar
36 Wang D, Chen B, Li W, Li J, Chen W. Risk factors on lung cancer: a meta-analysis. Chin. J. Evid-Based Med. 10(12), 1446–1449 (2010).Google Scholar
37 Zhao Y, Wang S, Aunan K, Seip HM, Hao J. Air pollution and lung cancer risks in China – a meta-analysis. Sci. Total Environ. 366(2–3), 500–513 (2006).Crossref, Medline, CAS, Google Scholar
38 Kim C, Gao YT, Xiang YB et al. Home kitchen ventilation, cooking fuels, and lung cancer risk in a prospective cohort of never smoking women in Shanghai, China. Int. J. Cancer 136(3), 632–638 (2015).Medline, CAS, Google Scholar

Vol. 15, No. 9

Supplemental Materials

Metrics

Downloaded 106 times

History

Received 27 October 2018

Accepted 17 December 2018

Published online 15 January 2019

Published in print March 2019

Information

Keywords

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: https://www.futuremedicine.com/doi/suppl/10.2217/fon-2018-0818

Author contributions

The authors were fully responsible for all content and editorial decisions, involved at all stages of manuscript development and have approved the final version.

Financial & competing interests disclosure

This study was supported by the following grants: the Project of Postdoctoral Innovation of Shandong Province (grant numbers: 201501010 and 201601006), the Project of Postdoctoral Science Foundation of China (grant number: 2016M590640) and Key Research and Development Program of Shandong Province (grant number: 2016CYJS01A03). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Disclaimer

I certify that I am the corresponding author for this manuscript. The manuscript is submitted with the knowledge and on behalf of the listed co-authors. I certify that each co-author listed above participated sufficiently in the work to take responsibility for the content and that all those who qualify are listed.

Ethical conduct of research

The authors state that they have followed the principles outlined in the Declaration of Helsinki and the study was approved by the Ethics Committee of Shandong Cancer Hospital Affiliated to Shandong University.

PDF download