Predictive Value of High Preoperative Serum Total Protein and Elevated Hematocrit in Patients with Non-Small-Cell Lung Cancer after Radical Resection

Figures & data

Figure 1. Diagram depicting the research cohort screening process.

Table 1. Characteristics of all patients.

Characteristics	Cases (n = 100)	Percentage (%)
Age (years)
Median (range)	60.5 (22–81)
≤65	65	65
≥65	35	35
Gender
Male	66	66
Female	34	34
BMI
Median (range)	22.9 (17.2–31.2)
<24 kg/m^2	65	65
≥24 kg/m^2	35	35
Histological
Adenocarcinoma	47	47
Non-adenocarcinoma	53	53
Smoking status
Non-smokers	41	41
Smokers	59	59
Drinking status
Non-drinkers	68	68
Drinkers	32	32
Diagnosis of diabetes
Non-diabetics	91	91
Diabetics	9	9
Diagnosis of hypertension
Non-hyperpietics	84	84
Hyperpietics	16	16
Disease stage
I	19	19
II–III	81	81
Radiotherapy
0	97	97
1	3	3

Abbreviations: BMI, body mass index.

Table 2. The alterations of nutrition indexes in all patients.

Nutrition-related indications	Mean ± SD	P value*
RBC (×10^12/L)		.259
Level at diagnosis	4.72 ± 0.60
Level at follow-up	4.66 ± 0.70
Difference^a	−0.06 ± 0.57
HGB (g/L)		.005
Level at diagnosis	138.78 ± 14.48
Level at follow-up	134.23 ± 16.83
Difference^a	−4.55 ± 15.68
MCV (fL)		.041
Level at diagnosis	90.06 ± 7.24
Level at follow-up	88.41 ± 9.27
Difference^a	−1.65 ± 7.98
HCT (%)		.517
Level at diagnosis	42.13 ± 3.82
Level at follow-up	41.68 ± 6.94
Difference^a	−0.45 ± 6.92
MCH (pg)		.964
Level at diagnosis	29.68 ± 3.02
Level at follow-up	29.71 ± 6.85
Difference^a	0.03 ± 6.66
TP (g/L)		.639
Level at diagnosis	73.79 ± 9.18
Level at follow-up	73.16 ± 10.96
Difference^a	0.05 ± 15.19
ALB (g/L)		.081
Level at diagnosis	42.20 ± 4.49
Level at follow-up	43.14 ± 4.79
Difference^a	0.93 ± 5.29
GLOB (g/L)		.429
Level at diagnosis	30.45 ± 4.98
Level at follow-up	30.90 ± 5.00
Difference^a	0.45 ± 5.71
AGR		.422
Level at diagnosis	1.41 ± 0.24
Level at follow-up	1.43 ± 0.25
Difference^a	0.02 ± 0.21

Abbreviations: RBC, red blood cell; HGB, hemoglobin; MCV, mean corpuscular volume; MCH, mean corpuscular hemoglobin; HCT, hematocrit; and TP, total protein; ALB, albumin; GLOB, globulin; AGR, albumin to globulin ratio. Data are mean ± standard deviations.

a Difference = nutrition-related indications follow-up − nutrition-related indications at diagnoses.

* Compared with paired t-test.

Bold values represent p < 0.05.

Figure 2. X-Tile analysis of the total risk score and survival according to the optimal cutoff levels of TP (A–C), ALB (D–F), and GLOB (G–I), AGR (J–L).

Figure 3. Survival curves according to the cutoff levels of baseline TP, ALB, GLOB, and AGR determined by X-Tile, and survival curves according to fluctuations in HCT and MCV levels. (A) Significant difference in DFS between patients with baseline TP higher than 76.66 g/L and those with TP lower than 76.66 g/L (75% vs. 50%, P = .027). (B) Significant difference in DFS between patients with baseline ALB higher than 37.7 g/L and those with ALB lower than 37.7 g/L (60% vs. 26.7%, P = .002). (C) Significant difference in DFS between patients with baseline GLOB higher than 31.42 g/L and those with GLOB lower than 31.42 g/L (62.7% vs. 39.4%, P = .037). (D) Significant difference in DFS between patients with baseline AGR higher than 1.31 and those with AGR lower than 1.31 (63.5% vs. 40.5%, P = .006). (E) Significant difference in DFS between patients with HCT elevation and those with HCT reduction after surgery compared to the baseline (69.8% vs. 43.9%, P = .013). (F) Significant difference in DFS between patients with MCV elevation and those with MCV reduction after surgery compared to the baseline (73.2% vs. 42.4%, P = .014).

Table 3. The baseline nutrition-related indications for DFS.

Nutrition-related indications	N (%)	DFS (%)	P value
RBC^a			.200
High	68	57.4
Low	32	50.0
HGB^a			.145
High	11	36.4
Low	89	57.3
MCV^a			.148
High	21	66.7
Low	79	51.9
HCT^a			.237
High	20	45
Low	80	57.5
MCH^a			.148
High	18	66.7
Low	82	52.4
TP^a			.027
High	20	75.0
Low	80	50.0
ALB^a			.002
High	85	60.0
Low	15	26.7
GLOB^a			.037
High	33	39.4
Low	67	62.7
AGR^a			.006
High	63	63.5
Low	37	40.5

Abbreviations: DFS, disease-free survival.

a Comparison between baseline nutrition-related indications of high and low.

Bold values represent p < 0.05.

Table 4. The nutrition-related indications alterations for DFS.

Nutrition-related indications	N (%)	DFS (%)	P value
RBC^a			.241
Elevation	44	63.6
Reduction	56	48.2
HGB^a			.281
Elevation	39	64.1
Reduction	61	49.2
MCV^a			.014
Elevation	41	73.2
Reduction	59	42.4
HCT^a			.013
Elevation	43	69.8
Reduction	57	43.9
MCH^a			.925
Elevation	33	60.6
Reduction	67	52.2
TP^a			.361
Elevation	58	51.7
Reduction	42	59.5
ALB^a			.822
Elevation	57	54.4
Reduction	43	55.8
GLOB^a			.784
Elevation	50	52.0
Reduction	50	58.0
AGR^a			.500
Elevation	52	59.6
Reduction	48	50.0

Abbreviations: DFS, disease-free survival.

a Comparison between nutrition-related indications follow-up and nutrition-related indications at diagnoses.

Bold values represent p < 0.05.

Table 5. Predictive factors for DFS by univariate and multivariate analysis.

	Univariate analysis		Multivariate analysis
	HR (95% CI)	P value	HR (95% CI)	P value
Gender
Female	1.000 (ref.)
Male	1.663 (0.858–3.225)	.132
Year
≥65	1.000 (ref.)		1.000 (ref.)
<65	0.540 (0.295–0.987)	.045	0.479 (0.239–0.961)	.038
BMI
≥24 kg/m^2	1.000 (ref.)
<24 kg/m^2	0.902 (0.493–1.648)	.736
Histological
Non-adenocarcinoma	1.000 (ref.)		1.000 (ref.)
Adenocarcinoma	0.412 (0.224–0.757)	.004	0.456 (0.229–0.907)	.025
Disease stage
II–III	1.000 (ref.)
I–0	0.568 (0.252–1.278)	.171
Smoking status
Smokers	1.000 (ref.)
Non-smokers	0.664 (0.360–1.224)	.189
Drinking status
Drinkers	1.000 (ref.)
Non-drinkers	0.951(0.511–1.772)	.875
Diabetes
Diabetics	1.000 (ref.)		1.000 (ref.)
Non-diabetics	0.443 (0.187–1.052)	.065	0.871(0.315–2.409)	.791
Hypertension
Hyperpietics	1.000 (ref.)
Non-hyperpietics	0.734 (0.327–1.645)	.453
Radiotherapy
Radiotherapy	1.000 (ref.)
Non-radiotherapy	0.544 (0.131–2.257)	.402
Baseline RBC
High	1.000 (ref.)
Low	1.488 (0.807–2.742)	.203
Baseline HGB
High	1.000 (ref.)
Low	0.552 (0.245–1.242)	.151
Baseline MCV
High	1.000 (ref.)
Low	1.801(0.803–4.043)	.154
Baseline HCT
High	1.000 (ref.)
Low	0.663 (0.334–1.317)	.241
Baseline MCH
High	1.000 (ref.)
Low	1.872 (0.789–4.444)	.155
Baseline TP
High	1.000 (ref.)		1.000 (ref.)
Low	2.736 (1.079–6.941)	.034	3.015 (1.055–8.610)	.039
Baseline ALB
High	1.000 (ref.)		1.000 (ref.)
Low	2.890 (1.451–5.754)	.003	2.044 (0.860–4.855)	.105
Baseline GLOB
High	1.000 (ref.)		1.000 (ref.)
Low	0.540 (0.299–0.974)	.041	0.538 (0.207–1.393)	.201
Baseline AGR
High	1.000 (ref.)		1.000 (ref.)
Low	2.229 (1.238–4.012)	.008	1.312 (0.515–3.341)	.569
RBC
Elevation	1.000 (ref.)
Reduction	1.438 (0.781–2.650)	.244
HGB
Elevation	1.000 (ref.)
Reduction	1.413 (0.751–2.660)	.284
MCV
Elevation	1.000 (ref.)		1.000 (ref.)
Reduction	2.289 (1.160–4.519)	.017	1.524 (0.738–3.147)	.254
HCT
Elevation	1.000 (ref.)		1.000 (ref.)
Reduction	2.218 (1.162–4.235)	.016	2.417 (1.214–4.811)	.012
MCH
Elevation	1.000 (ref.)
Reduction	1.031 (0.540–1.971)	.926
TP
Elevation	1.000 (ref.)
Reduction	0.756 (0.413–1.382)	.363
ALB
Elevation	1.000 (ref.)
Reduction	0.934 (0.516–1.691)	.822
GLOB
Elevation	1.000 (ref.)
Reduction	0.921 (0.513–1.656)	.784
AGR
Elevation	1.000 (ref.)
Reduction	1.223 (0.681–2.197)	.501

Abbreviations: DFS, disease-free survival; HR, hazard ratio; CI, confidence interval.

Bold values represent p < 0.05.