aot2022v55i2

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Acta Oncologica Turcica 2022; 55: 147-158150performed on a monthly basis and thoracicabdominalcomputed tomography (CT) testwas performed when necessary. Follow-upvisits were provided bimonthly for the firstyear, quarterly in the 2nd and 3rd years, semiannuallyin the 4th and 5th years, and thenannually. Thoracic-abdominal CT wasperformed at each visit, and cerebral magneticresonance imaging (MRI) or CT wasperformed every three months in the first yearand every six months for two years after thefirst year.Study EndpointsProgression-free survival (PFS) was definedas the time from diagnosis to diseaseprogression or death. OS was defined as theperiod from the time of diagnosis until deathor the last follow-up period for living patients.StatisticsThe receiver operating characteristic (ROC)curve analysis was performed to determine thebest cut-off value for variables and the areasunder the curve (AUCs) were calculated.CAR, PCR, PNI and FAR were evaluated asdichotomized variables by obtaining the bestcut-off value. Shapiro–Wilk test was used todetermine if variables were normallydistributed. The Chi-square (χ 2 ) test orFisher’s exact test was used to analyze therelationship between the group of low andhigh CAR, PCR, PNI and FAR with clinicpathologicalparameters. Associationsbetween parameters and survival wereanalyzed using Kaplan–Meier curves andwere compared by the log-rank test. Hazardratios (HRs), estimated from the Cox analysis,were reported as relative risks withcorresponding 95% confidence intervals(CIs). All variables with a p-value <0.05 in theunivariate analysis were included inmultivariate Cox regression analysis withbackward selection. p < 0.05 was consideredstatistically significant in multivariate Coxregression analysis. All analyses wereperformed using the SPSS statistical softwarepackage (SPSS Version, 21, Armonk; NY:IBM Corp).ResultsDetermining Optimal Cut-off Values of FARand Other ParametersAccording to ROC curve analysis, best cut-offpoint for FAR was 0.138, providing 72%sensitivity and 64% specificity. Cut-off valuesfor highest sensitivity and specificity forCAR, PCR and PNI were 0.646, 6.1 and 33.9,respectively. FAR had the highest AUC (0.73)among prognostic factors. AUC values forCAR (0.63), PCR (0.60) and PNI (0.68) werefound to be as indicated. The cut-off valuedetermined by the local laboratory was usedfor serum LDH level (243).Relationship between FAR with Clinical andPathological VariablesMedian age of 145 patients included in thestudy was 65±9.5 years. 43 of patients(29.7%) were 60 years and of age and youngerand 102 (70.3%) were above 60 years. Theclinical and demographic characteristics ofthe patients are shown in Table 1. Higher FARwas significantly related to; poor ECOGperformance status, extensive stage, numberof extrapulmonary lesions, higher CAR andhigher PCR (p:0.001, p:0.008, p:0.0025,p:0.031, p:0.003 respectively).Relationship between Survival Results withFAR and Other ParametersAt the end of a median follow up of 15± 15.3months; while 66 (45.5%) patients showedprogression, 40 (27.6%) patients have losttheir lives.According to Kaplan Meier analysis, in thegroup with FAR≥0.138, both PFS (11.7months vs. 42.1 months, p<0.001) and OS(16.6 months vs. 64.3 months, p<0.001) werefound to be short. Both PFS and OS werefound to be shorter in patients with high ECOGwww.actaoncologicaturcica.comCopyright©Ankara Onkoloji Hastanesi
Acta Oncologica Turcica 2022; 55: 147-158151Table 1. Clinical and demographic characteristics of patientsn (%)Age groups (years)≤ 60 43 (29.7)> 60 102 (70.3)GenderMale 133(91.7)Female 12 (8.3)ECOG0 49 (33.8)1 61 (42.1)2 35 (24.1)SmokingYes 71 (49)No 74 (51)ComorbidityYes 92 (63.4)No 53 (36.6)StageLimited 65 (44.8)Extensive 80 (55.2)PCIYes 18 (12.4)No 127(87.6)Thoracic RTYes 29 (20)No 116 (80)Palliative RTYes 11 (7.6)No 134 (92.4)Extrapulmonary lesion0 65 (44.8)1 40 (27.6)2 40 (27.6)LDH< 243 41 (28.3)≥ 243 104 (71.7)PNI< 33.9 60 (41.4)≥ 33.9 85 (58.6)CAR< 0.646 79 (54.5)≥ 0.646 66 (45.5)FAR< 0.138 72 (49.7)≥ 0.138 73 (50.3)PCR< 6.1 107 (73.8)≥ 6.1 38 (26.2)ECOG Eastern Cooperative Oncology Group performance status, TNM tumor, node, metastasis, PCI prophylacticcranial irradiation, Thoracic RT: Thoracic Radiotherapy, Palliative RT: Palliative Radiotherapy, LDH: lactatedehydrogenase, CAR C‐reactive protein/ albumin ratio, PCR procalcitonin/ C-reactive protein ratio, PNI prognosticnutritional index, FAR fibrinojen-to-albumin ratio,www.actaoncologicaturcica.comCopyright©Ankara Onkoloji Hastanesi
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